A 28-year-old female with a history of contact lens wear presented with a 1 week history of pain and photophobia in her left eye.In Course a pied - Femme - Vetements - Short vivo confocal microscopy (IVCM) and corneal scrape confirmed the diagnosis of Acanthamoeba keratitis (AK) which was treated with intensive topical propamidine isethionate (0.1%) and chlorhexidine (0.
02%) with tapering dosage over 11 months.Five years after complete resolution of AK and cessation of all contact lens wear, the subject presented to her optometrist with a history of ocular discomfort and mild photophobia.Without further investigation she was prescribed topical corticosteroids.
Three weeks later she presented with pain and reduced vision in the left eye.Slit-lamp examination revealed focal, inferior corneal stromal edema.IVCM confirmed widespread Acanthamoeba cysts.
Treatment with topical polyhexamethylene biguanide (PHMB) 0.02% and propamidine isethionate 0.1% resulted in resolution of the AK.
Despite an initially mild AK, this subject presumably retained viable Acanthamoeba cysts in her cornea 5 years after the initial episode.This report highlights the importance of caution when using corticosteroids lotion in patients with a previous history of AK, even in the relatively distant past.Patients with AK should be warned regarding the risks of recurrence following presumed resolution.