Bilateral Acanthamoeba Keratitis in Synergeyes Contact Lens Wear: Clinical and Confocal Microscopy Findings

OBJECTIVE: To report three cases of bilateral Acanthamoeba keratitis in association with Synergeyes hybrid contact lens wear. METHODS: Retrospective case series of six eyes of three patients that developed Acanthamoeba keratitis with Synergeyes hybrid contact lens wear. RESULTS: Acanthamoeba keratitis was diagnosed in six eyes with a previous misdiagnosis of Herpes simplex keratitis in two patients and a misdiagnosis of corneal graft rejection in the third patient. Misdiagnosis in all three patients led to inappropriate topical corticosteroid use. All cases were diagnosed with Acanthamoeba castellanii by culture on nonnutrient agar, corneal scraping, and/or confocal microscopy. The infection ultimately cleared in all eyes with topical therapy using chlorhexidine, propamidine, and antibiotic ointment with neomycin. Cornea transplantation was required in two of six eyes for dense central corneal scarring. CONCLUSIONS: Acanthamoeba keratitis can occur in association with SynergEyes contact lens wear. Eye care professionals must take care to avoid potential misdiagnosis of Herpes simplex keratitis, avoid topical corticosteroids in contact lens wearers with an unknown keratitis, and pay special attention to the fellow eye for potential bilateral infection when Acanthamoeba has been diagnosed in one eye.