To the Editor.
—A 32-year-old soft contact lens wearer was referred with bilateral corneal infiltrates of approximately three weeks' duration. The patient had used salt tablets and distilled water for sterilization.Slit-lamp examination of the right cornea (Fig 1) showed three to four linear tracks in the stroma extending to the periphery and resembling "highlighted" nerves. A corneal biopsy specimen overlying the stromal infiltrates was obtained, and the patient began receiving topical therapy with 0.1% propamidine isethionate (Brolene) and bacitracin zinc-neomycin sulfate-polymyxin B sulfate (Neosporin) ophthalmic solution hourly. Steroid therapy was later added to try to decrease the inflammatory reaction as well as some of the pain associated with this condition. Scrapings were negative using calcofluor white; however, the biopsy and cultures confirmed Acanthamoeba keratitis1,2 (Fig 2).This patient, with bilateral corneal infiltrates and an intact epithelium, was diagnosed as having Acanthamoeba keratitis. Previously, we described radial keratoneuritis3
Insler MS, Portnoy SL, Beuerman RW, Kaufman HE. Radial Intrastromal Lines in Acanthamoeba Keratitis. Arch Ophthalmol. 1988;106(7):883. doi:10.1001/archopht.1988.01060140025012