Abstract
Purpose
To present a case of corneal toxicity caused by therapeutic duplication during treatment of acanthamoeba keratitis as a complication of contact lens use.
Case summary
A 12-year-old girl with a history of wearing orthokeratology contact lenses and a 14-year-old girl with a history of wearing cosmetic contact lenses presented with ocular pain, injection, and decreased visual acuity. They were diagnosed as having acanthamoeba keratitis based on slit lamp examination, confocal microscopy and culture. After the patients were treated with polyhexamethylene biguanide (PHMB) and chlorhexidine, corneal epithelial defect and erosion occurred. Use of chlorhex-idine was stopped, and PHMB was used to treat patients and recovery of the corneal epithelium with improvement in symptoms of acanthamoeba keratitis was found.
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Figure 1.
(A) Slit-lamp photograph and flurescein stain of the right cornea of a 12-years-old girl with a history of wearing orthoker-atology contact lenses. (B) Acanthamoeba track on the culture on E. coli plated agar media from contact lens. (C) In vivo laser confocal microscopic images of the right cornea. In the stroma numerous highly reflective, spindle-shaped materials were aggravated (arrows). (D) Slit-lamp photograph and ulcerated lesion was stained under PHMB and chlorhexidine administration. (E) After 1 day of stopping chlorhexidine use, corneal and conjunctival lesion improved. (F) After 2 months, residual corneal subepithelial opacity remained, and no corneal stain lesion is seen. PHMB = polyhexamethylene biguanide.
![jkos-56-280f1.tif](/upload/SynapseXML/0035jkos/thumb/jkos-56-280f1.gif)
Figure 2.
(A) A 14-year-old girl with a history of wearing cosmetic contact lenses presented with corneal circinate infiltrate in the left eye. (B) In vivo laser confocal microscopic images of the cornea of the left eye of case 2. In the stroma around the keratoneuritis, highly reflective activated keratocytes formed a honeycomb pattern (arrows). (C) Punctate epithelial keratitis, corneal haze, con-junctival injection, and perilimbal vascularization are observed under PHMB and chlorhexidine administration. (D) After 5 months; residual mild corneal opacity remains. PHMB = polyhexamethylene biguanide.
![jkos-56-280f2.tif](/upload/SynapseXML/0035jkos/thumb/jkos-56-280f2.gif)