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Taiwan J Ophthalmol. 2019 Apr-Jun;9(2):131-133. doi: 10.4103/tjo.tjo_114_17.

Dendrite-like anterior stromal keratitis coinfected with Acanthamoeba and Pseudomonas in an orthokeratology contact lens wearer.

Hsu CC1,2.

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Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan.
Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.


Acanthamoeba species can cause a keratitis misdiagnosed as herpes keratitis or fungal keratitis. We report an unusual dendrite-like anterior stromal keratitis coinfected with Acanthamoeba and Pseudomonas aeruginosa in an orthokeratology contact lens wearer in Taiwan. Topical 1% voriconazole and 0.5% levofloxacin were prescribed because besides Acanthamoeba keratitis, fungal keratitis was also highly suspected initially. Topical 0.02% chlorhexidine was added after the culture of the scraped cornea showed positive results of Acanthamoeba and P. aeruginosa. The lesion subsided using this triple combination therapy for 1 week. Both Acanthamoeba and P. aeruginosa are potentially devastating causes of infectious keratitis. Our case highlights the importance of considering the possibility of a concurrent infection and atypical presentation in cases with contact lens-related keratitis. The use of topical levofloxacin combined with voriconazole should be considered as the first-line treatment in such patients.


Acanthamoeba keratitis; Pseudomonas; coinfection; levofloxacin; orthokeratology

Conflict of interest statement

The authors declare that there are no conflicts of interests of this paper.

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