The n e w e ng l a n d j o u r na l
Images in Clinical Medicine
Lanxing Fu, M.B., Ch.B.,
F.R.C.Ophth.
Manchester Royal Eye Hospital
Manchester, United Kingdom
lana.fu@mft.nhs.uk
Ahmed Gomaa, M.B., Ch.B,
M.D., F.R.C.S.
Blackpool Victoria Hospital
Blackpool, United Kingdom
274
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of m e dic i n e
Chana A. Sacks, M.D., Editor
Acanthamoeba Keratitis
A
41-year-old woman presented to the ophthalmology clinic
with a 2-month history of intermittent pain, blurry vision, and sensitivity
to light in her left eye. She wore monthly disposable soft contact lenses that
she kept in her eyes while swimming and showering. The patient had difficulty
keeping her left eye open during the physical examination, which revealed redness
of the conjunctiva. The visual acuity was 20/20 in the right eye and 20/200 in the
left eye. A large, ring-shaped infiltrate was present in the left eye, along with corneal
haze and an overlying epithelial defect, which showed uptake of fluorescein dye.
Cultures from corneal scrapings grew Acanthamoeba polyphaga. She received a diag-
nosis of acanthamoeba keratitis, a vision-threatening infection most commonly
associated with contact lens wear. The patient was treated with topical poli-
hexanide and propamidine isethionate. Although the infection resolved, the vision
in her left eye was not restored, owing to a dense, central corneal scar and cata-
ract. Twelve months after the initial presentation, the patient underwent deep
anterior lamellar keratoplasty, which resulted in a postoperative visual acuity of
20/80 and no discomfort in her left eye.
DOI: 10.1056/NEJMicm1817678
Copyright © 2019 Massachusetts Medical Society.
n engl j med 381;3 nejm.org July 18, 2019
The New England Journal of Medicine
Copyright © 2019 Massachusetts Medical Society. All rights reserved.