Twenty-eight years old woman with the history of trauma to her right eye 2 months ago, had mild stinging and tearing sensations in the mornings since then and needed to use eye patch time to time. Three days before referral, she was handled by a therapeutic contact lens (CL) with the diagnosis of corneal epithelial defect. She applied to our clinic with intolerable pain despite CL. There was a corneal lesion with haze in its base and surrounded with corneal edema. Corneal confocal images revealed hyperreflective cystic lesions that were bringing a suspicion of Acanthamoeba keratitis (AK). The lesion healed within 10 days, which was an unexpected course and cultures taken before the initiation of treatment were negative.
The positive history for trauma and CL wear, the presence of severe pain, corneal findings and detection of cysts in confocal microscopy brought up the suspicion of AK as differential diagnosis. However, negative culture results, faster response to treatment than expected, the possibility of similar confocal findings in healing epithelium, the final diagnosis was concluded as to be recurrent epithelial erosion. Since, a possible AK may cause loss of vision, in case of suspicion the samples should be obtained for microbiological study, and patients should be followed closely for clinical course until the final diagnosis is achieved.