Conservative treatment. Hospitalization is recommended when beginning treatment as the disorder requires protracted therapy. Systemic therapy is only indicated in the case of an intraocular involvement. Other cases will respond well to topical treatment with antimycotic agents such as natamycin, nystatin, and amphotericin B. In general, the topical antimycotic agents will have to be specially prepared by the pharmacist.
Surgical treatment. Emergency keratoplasty (see p. 152) is indicated when the disorder fails to respond or responds too slowly to conservative treatment and findings worsen under treatment.
5.4.7 Acanthamoeba Keratitis
Epidemiology: This is a rare type of keratitis and one which may have been diagnosed too rarely in the past.
Etiology: Acanthamoeba is a saprophytic protozoon. Infections usually occur in wearers of contact lenses, particularly in conjunction with trauma and moist environments such as saunas.
Symptoms: Patients complain ofintense pain, photophobia, and lacrimation.
Diagnostic considerations: The patient will often have a history of several weeks or months of unsuccessful antibiotic treatment.
Inspection will reveal a unilateral reddening of the eye. Usually there will be no discharge. The infection can present as a subepithelial infiltrate, as an intrastromal disciform opacification of the cornea, or as a ring-shaped corneal abscess (Fig. 5.10a).
The disorder is difficult to diagnose, and even immunofluorescence studies in specialized laboratories often fail to provide diagnostic information. Amebic cysts can be readily demonstrated only by histologic and pathologic studies of excised corneal tissue (Fig. 5.10b). Recently it has become possible to demonstrate amebic cysts with the aid of confocal corneal microscopy (see p. 125). Patients who wear contact lenses should have them sent in for laboratory examination.
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