Case #7:

Clinical Presentation:
A 25 year old man presents with exquisite eye pain and irritation. He is a contact lens wearer with poor lens hygiene. He sometimes used tap water for lens cleaning. Case 7 Image 1 shows inflammation of the conjunctiva and the cornea (Keratitis).

Clinical Diagnoses:
Bacterial (esp Pseudomonas spp), Fungal or Viral Keratitis with Conjunctivitis

Case 7 Image 2: Gram staining of contact lens solution demonstrates a large single-celled organism containing phagocytosized gram-negative bacilli within vacuoles and adherent to its surface.

Discussion:
Microbiologic Diagnosis:
Acanthamoeba Keratitis
Trophozoites and cysts of this protozoa can also be found in corneal scrapings obtained by opthamologists. This environmental organism is transmitted by contamination of contact lens solution with non-sterile water.