Radial keratoneuritis as a presenting sign in acanthamoeba keratitis

• Published in: Middle East African journal of ophthalmology Vol. 18; no. 3; pp. 252 - 255
• Main Author: Alfawaz, Abdullah
• Format: Journal Article
• Language: English
• Published: India Medknow Publications and Media Pvt. Ltd 01.07.2011; Medknow Publications & Media Pvt. Ltd; Medknow Publications
• Subjects: Acanthamoeba keratitis; Care and treatment; Case Report; Causes of; Cornea; Diagnosis; Emergency medical care; Eyes & eyesight; Patient outcomes; Transplantation; Acanthamoeba Keratitis; Radial Keratoneuritis; Keratitis
• ISSN: 0974-9233; 0975-1599; 0975-1599; 0974-9233
• DOI: 10.4103/0974-9233.84062

The visual outcomes of Acanthamoeba keratitis, a rare cause of corneal infection, can be devastating. This paper reports two contact lens wearers with severe pain and photophobia who presented to the emergency room. Biomicroscopy revealed radial keratoneuritis in both individuals. Tissue culture on a nonnutrient agar plate with Escherichia coli overlay resulted in a heavy growth of Acanthamoeba. The inpatient treatment included 0.02% polyhexamethylene biguanide, chlorhexidine, neomycin/polymyxin B/bacitracin (Neosporin), and oral fluconazole, which successfully controlled the corneal infection and improvement in the best corrected visual acuity in both patients. Infection did not recur during the 12-month follow-up period. Acanthamoeba keratitis can present as radial keratoneuritis, mimicking other common corneal infections resulting in diagnostic and treatment delays. Early diagnosis and prudent treatment of Acanthamoeba keratitis are the keys to restoring vision and avoiding the subsequent need for penetrating keratoplasty.