Acanthamoeba keratitis is uncommon and rarely reported in Korea. It has been reported in world literature as a very severe, progressive necrotizing stromal keratitis due to a non-parasitic free-living amoeba. It is frequently associated with minimal corneal trauma especially from contact lens but sometimes occurs in patients without any past history. We report a case of acanthamoeba keratitis without a specific past history in a 42-year-old man. Light and electron microscopy demonstrated severe stromal keratitis with numerous thick-walled cysts, 10~15 m in diameter, scattered in the superficial and deep stroma. Because this keratitis is most often mistaken for fungal, bacterial or herpetic keratitis, early confirmatory diagnosis by direct smear, biopsy or culture is essentially required for the prevention of visual loss or devastating eyeball loss.
Acanthamoeba Keratitis* ; Acanthamoeba* ; Adult ; Amoeba ; Biopsy ; Diagnosis ; Humans ; Keratitis ; Keratitis, Herpetic ; Korea ; Microscopy, Electron

Herpes simplex virus keratits(HSK) is one of the most common external eye diseases that cause corneal blindness, Therefore early diagnosis and proper treatment of HSK are essential. However it is frequently misdiagnosed because it shows non-specific corneal lesion than other infectious corneal disease. And also diagnosis of HSK mostly rely on clinical examination and patient history. We evaluated suspicious HSK patients by indirect immunofluofluorescent(IF) antibody test and analyzed its efficacy in the early diagnosis of HSK. Among 47 patients(47 eyes), 37 patients were suspicious heretic keratitis and others not. Dendritic keratitis patients existed in 17 out of 37 patients and they were evaluated with virus culture and indirect IF test. The result of indirect IF test was confirmed under the immunofluorescent microscope and for virus culture the specimens were inoculated on Vero cells(monkey kidney cells). The positive results of indirect IF test was 28 out of 37 suspicious HSK patients and 1 out of 10 non-suspicious HSK patients. Dendritic HSK patients showed IF positive in 15 out of 17 patients(82.3%). Sensitivity of indirect IF test in suspicious HSK patients was 75.7%(2837) and 88.2%(15/17) in dendritic HSK patients. Indirect IF test was all positive(14/14) in dendritic HSK patients that showed culture positive. From these results, indirect IF test has a high sensitivity in early diagnosis of HSK and might be ussful as a rapid diagnostic tool in HSK patients.
Blindness ; Corneal Diseases ; Diagnosis ; Early Diagnosis ; Eye Diseases ; Herpes Simplex* ; Humans ; Keratitis ; Keratitis, Dendritic ; Keratitis, Herpetic* ; Kidney ; Simplexvirus

Herpes simplex virus keratits(HSK) is one of the most common external eye diseases that cause corneal blindness, Therefore early diagnosis and proper treatment of HSK are essential. However it is frequently misdiagnosed because it shows non-specific corneal lesion than other infectious corneal disease. And also diagnosis of HSK mostly rely on clinical examination and patient history. We evaluated suspicious HSK patients by indirect immunofluofluorescent(IF) antibody test and analyzed its efficacy in the early diagnosis of HSK. Among 47 patients(47 eyes), 37 patients were suspicious heretic keratitis and others not. Dendritic keratitis patients existed in 17 out of 37 patients and they were evaluated with virus culture and indirect IF test. The result of indirect IF test was confirmed under the immunofluorescent microscope and for virus culture the specimens were inoculated on Vero cells(monkey kidney cells). The positive results of indirect IF test was 28 out of 37 suspicious HSK patients and 1 out of 10 non-suspicious HSK patients. Dendritic HSK patients showed IF positive in 15 out of 17 patients(82.3%). Sensitivity of indirect IF test in suspicious HSK patients was 75.7%(2837) and 88.2%(15/17) in dendritic HSK patients. Indirect IF test was all positive(14/14) in dendritic HSK patients that showed culture positive. From these results, indirect IF test has a high sensitivity in early diagnosis of HSK and might be ussful as a rapid diagnostic tool in HSK patients.
Blindness ; Corneal Diseases ; Diagnosis ; Early Diagnosis ; Eye Diseases ; Herpes Simplex* ; Humans ; Keratitis ; Keratitis, Dendritic ; Keratitis, Herpetic* ; Kidney ; Simplexvirus

We evaluated the efficacy of polymerase chain reaction(PCR)in the early diagnosis of Herpes simplex virus keratitis(HSK). Among 47 patients(47 eyes), 25 patients were clinically herpetic keratitis and the others were other kinds of keratitis clinically. Tear film specimens were taken from 32 eyes and corneal scrapings from 21 eyes with suspicious herpetic keratitis and clinically incongrous with HSK. PCR for tear and corneal scraping was performed with using DNA primer. 67% of corneal scrapings and 19%tear samples of suspicious herpetic keratitis showed PCR positive. Tear samples from keratitis clinically incongruous with HSK were all PCR negative but 40%of corneal scrapings from these patients represented PCR positive. From these results, PCR is a rapid and effective tool for the early diagnosis of herpetic keratitis and especially useful in cases of nonspecific corneal lesion. However, for the accurate diagnosis of HSK, not only PCR results but also patient's history and corneal findings should be well evaluated.
Diagnosis ; DNA ; Early Diagnosis* ; Humans ; Keratitis ; Keratitis, Herpetic ; Polymerase Chain Reaction* ; Simplexvirus ; Tears

Laboratory diagnostic methods, applied for the diagnosis of Acanthamoeba Keratitis, were evaluated for their usefulness in 16 patients of suspicious Acanthamoeba keratitis. Wet smear, Acridine orange(AO) stain, Gram stain and culture on nonnuturent agar plate were routinely used in all patients, and among them, and used saline of 7 contact lens not ideal for the corneal scraping specimens. AO and Gram stains were very useful in the identification of acanthamoeba, and culture on nonnutrient agar plates was essential to confirm this infection. Light and electron microscopic examinations were also useful in patients with negative results of ordinary diagnostic techniques. Suspicion of Acanthamoeba infection in patients that are recalcitrant to antibiotic treatment or related to contact lens wear, is the mont important step for the diagnosis of Acanthamoeba Keratitis. And also examination of corneal specimens by experienced observer is prerequisite for the accurate diagnosis of Acanthamoeba keratitis.
Acanthamoeba ; Acanthamoeba Keratitis ; Agar ; Clinical Laboratory Techniques* ; Coloring Agents ; Diagnosis ; Humans ; Keratitis*

In diagnostic methods of herpes simplex keratitis are included clinical appearance, cytology, viral culture, immunofluorescent technique, and identification with electron microscopy. We studied isolation rate of virus with viral culture method from 44 eyes that was clinically diagnosed as herpes simplex keratitis. Herpes simplex virus was isolated from 24 eyes among 44 eyes(56.8%). The result of viral culture showed a high positive isolation rates in superficial keratitis(72.0%) and relatively low rates in stromal keratitis(36.8%). The positive isolation rate was high in cases of short duration after the onset of herpes simplex keratitis. It is suggested that virus isolation with viral culture method is a relatively sensitive, simple, and highly specific method for the diagnosis of herpes simplex keratitis.
Diagnosis ; Herpes Simplex* ; Keratitis, Herpetic* ; Microscopy, Electron ; Simplexvirus

OBJECTIVEThe objective of this article was to review the current advances in diagnostic methods for Acanthamoeba keratitis (AK).

DATA SOURCESData used in this review were retrieved from PubMed (1970-2013). The terms "Acanthamoeba keratitis" and "diagnosis" were used for the literature search.

STUDY SELECTIONData from published articles regarding AK and diagnosis in clinical trials were identified and reviewed.

RESULTSThe diagnostic methods for the eight species implicated in AK were reviewed. Among all diagnostic procedures, corneal scraping and smear examination was an essential diagnostic method. Polymerase chain reaction was the most sensitive and accurate detection method. Culturing of Acanthamoeba was a reliable method for final diagnosis of AK. Confocal microscopy to detect Acanthamoeba was also effective, without any invasive procedure, and was helpful in the early diagnosis of AK.

CONCLUSIONClinically, conjunction of various diagnostic methods to diagnose AK was necessary.

Ocular rosacea is the eye manifestations of rosacea, which involves the lids, conjunctiva, and cornea. A recent study revealed that all patients with cutaneous rosacea had some degree of ocular involvement which is often undiagnosed. It is difficult to make a diagnosis of ocular rosacea because it lacks clinical or pathological hallmarks. However, early diagnosis and treatment are emphasized to decrease morbidity and prevent potential blindness. We report a case of ocular rosacea in a 49 year-old man who showed blepharoconjunctivitis, keratitis, and cutaneous manifestations of persistent erythema, telangiectasia, and papules. The ocular symptoms and signs had improved significantly with tetracycline therapy.
Blindness ; Conjunctiva ; Cornea ; Diagnosis ; Early Diagnosis ; Erythema ; Eye Manifestations ; Humans ; Keratitis ; Middle Aged ; Rosacea* ; Telangiectasis ; Tetracycline

We studied three patients who developed left unilateral punctate keratitis after suffering left-sided Wallenberg Syndrome. A complex evolution occurred in two of them. In all cases, neurophysiological studies showed damage in the trigeminal sensory component at the bulbar level. Corneal involvement secondary to Wallenberg syndrome is a rare cause of unilateral superficial punctate keratitis. The loss of corneal sensitivity caused by trigeminal neuropathy leads to epithelial erosions that are frequently unobserved by the patient, resulting in a high risk of corneal-ulcer development with the possibility of superinfection. Neurophysiological studies can help to locate the anatomical level of damage at the ophthalmic branch of the trigeminal nerve, confirming the suspected etiology of stroke, and demonstrating that prior vascular involvement coincides with the location of trigeminal nerve damage. In some of these patients, oculofacial pain is a distinctive feature.
Aged ; Cornea/*pathology ; Diagnosis, Differential ; Female ; Humans ; Keratitis/diagnosis/*etiology ; Lateral Medullary Syndrome/*complications ; Middle Aged

PURPOSE: To investigate the epidemiological, microbiological, and clinical characteristics of inpatients with infectious keratitis and also to elucidate risk factors for unimproved visual outcomes. METHODS: We performed a retrospective chart review of 167 eyes in 167 patients with infectious keratitis hospitalized between January 2005 and December 2007 at Yeungnam University Hospital. RESULTS: Keratitis cases were classified into four groups according to etiology: 92 bacterial, 43 herpes virus, 31 fungal, and 1 acanthamoeba. Culture positivity was 44.6% in bacterial keratitis and 22.6% in fungal keratitis, and KOH positivity of fungus was 48.4%. Of all the 55 isolated pathogens, the most commonly isolated microorganisms were S. epidermidis in Gram-positive bacteria, P. aeruginosa in Gram-negative bacteria, and Candida species in fungus. Epidemiologic characteristics such as male gender (59.9%), an age in the seventh decade (24.6%), farming occupation (40.1%), and trauma with vegetable matter (42.5%) were noted. Many fungal and bacterial keratitis cases were characterized by inadequate use of topical steroid when patients initially presented to our clinic. Visual outcomes were poorer in fungal keratitis than they were in other forms of keratitis. CONCLUSIONS: Risk factors for unimproved visual outcomes included an ulcer exceeding 3 mm in size and a fungal source. Therefore, a strong effort should be made to discern a differential diagnosis in infectious keratitis and to determine the appropriate early treatment for a successful treatment outcome.
Acanthamoeba ; Candida ; Diagnosis, Differential ; Eye ; Fungi ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Inpatients ; Keratitis ; Keratitis, Herpetic ; Male ; Occupations ; Retrospective Studies ; Risk Factors ; Treatment Outcome ; Ulcer ; Vegetables ; Viruses