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A 30 year old female was referred from another medical center because of contact lens related infectious keratitis in her left eye. She used to sleep with her contact lenses, and clean them with tap water. She reported on severe pain. On examination a central stromal infiltrate was seen. Peripheral linear infiltrates were compatible with radial kerato-neuritis. The combination of severe pain, radial corneal neuritis, and the history of contact lens abuse - all raised the suspicion of acanthamoeba keratitis. She was cultured for bacteria, fungi and acanthamoeba, and PCR was taken for HSV and acanthamoeba. All cultures and PCR were negative. She was managed empirically with fortified antibiotics and % chlorhexidine. As her corneal infiltrate gradually increased, repeated corneal samples were send for smears, cultures and PCR. However all were negative. During the next 2 months the keratitis worsened. Corneal transplantation was performed. Histological sections from the excised corneal button revealed multiple cysts. Cultures on covered non-nutrient agar revealed trophozoites and cysts. Following corneal transplantation the patient was maintained on topical %Chlorhexidine to prevent recurrence. Three months after surgery the corneal graft remained clear and the uncorrected visual acuity improved to 6/18. Microbiology photos (Acanthamoeba culturs, time lapse video and Calcofluor white sections) courtesy of Prof. Colin Block, Department of Clinical Microbiology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel. For more information please visit .
