Acanthamoeba epitheliopathy: Importance of early diagnosis

PURPOSE: To describe two cases of Acanthamoeba keratitis diagnosed and treated at the epithelial stage of disease and to underscore the importance of early diagnosis on prognosis. OBSERVATIONS: Case 1 is a 28-year-old male who developed Acanthamoeba keratitis after prolonged contact lens wear. Case 2 is a 43-year-old male with poor contact lens hygiene who was initially misdiagnosed and treated for herpetic keratitis. Both cases presented with epitheliopathy and were successfully treated with corneal epithelial debridement and topical anti-amoebic therapy, with complete avoidance of deeper extension of infection and associated complications. CONCLUSION AND IMPORTANCE: Epithelial stage Acanthamoeba keratitis represents a critical window of opportunity to achieve rapid cure. Acanthamoeba epitheliopathy may be mistaken for other conditions such as herpetic keratitis, contact lens overwear, or dry eye. Given worsening prognosis following delayed diagnosis, it is important for clinicians to be suspicious of Acanthamoeba keratitis in all contact lens wearers who develop elevated epitheliopathy.