Trauma-Associated Acanthamoeba Keratitis in a Non-Contact Lens User: Microbiological, Culture, and Histopathological Correlation- A Photoessay

Acanthamoeba keratitis is a rare but vision-threatening parasitic infection commonly associated with contact lens use; however, trauma and exposure to contaminated soil or water are important risk factors in non-contact-lens users. We report the case of a 51-year-old female farmer who presented with severe pain, redness, watering, and progressive visual loss in the right eye following insect-related ocular injury and subsequent washing with tap water. Initial investigations suggested microbial keratitis, and empirical antibacterial and antifungal therapy was initiated without improvement. Corneal scraping revealed Acanthamoeba cysts, and culture on non-nutrient agar with Escherichia coli overlay confirmed the diagnosis. The patient was treated with topical polyhexamethylene biguanide (PHMB) and chlorhexidine along with supportive therapy. Due to progressive corneal involvement, therapeutic keratoplasty was performed. Early microbiological diagnosis and prompt anti-amoebic therapy are essential to prevent visual loss. Acanthamoeba keratitis should be suspected in patients with environmental exposure even without contact lens use.