Acantamebic keratitis

Among many eye diseases, acanthamoebic keratitis is not particularly prevalent, although it does not have a particular sexual or age selectivity. This serious disease affecting the functionality of the cornea is primarily experienced by people with visual impairment using contact lenses. Therefore, it will be very useful to know what patients may encounter when choosing this method of vision correction, and how to avoid unpleasant consequences, without leading the situation to the need for surgical treatment and blindness.

What does the diagnosis mean?

In a medical environment, it is common to call inflammatory diseases identically by adding the suffix “-it” to the root. When it comes to inflammation of the cornea of the eye, the diagnosis sounds like “keratitis.” But the causes of inflammation can be different, so phrases are used to concretize them:

• if the cause was an eye injury - traumatic keratitis,
• with the viral nature of the disease - viral keratitis (with infection with the herpes virus - herpetic),
• with the parasitic nature of the pathology - parasitic keratitis (acanthamoebic, onchocercic), etc.

There are other types of keratitis, provoked by fungi, bacteria, sunburn of the eyes (one of the types of traumatic form of the disease).

Acanthamoebic keratitis is one of the varieties of the parasitic form of the disease. Its causative agent is the simplest, which is called "Akantameba." The ingress of this small parasite into the eye and subsequent reproduction leads to the fact that a person begins to feel discomfort in the eye and is hard to see both when wearing lenses and when they are removed. And instead of correction, he gets progressive visual impairment. And the reason here lies not in the lenses themselves, but in their improper use. [1]

Epidemiology

Statistics confirm that bathing in open waters with direct contact of lenses with water is in the first place among the causes of the development of acanthamoebic keratitis. About 90-96% of cases of detection of the disease belong to this category. Moreover, the likelihood of inflammation of the cornea is much higher when using soft contact lenses.

Previous studies have estimated prevalence from 1.2 per million adults and from 0.2 (US) to 2 (UK) per 10,000 soft contact lens users per year. [2] Parmar et al. Suggested that the incidence could be ten times higher. [3] A sharp increase in the incidence of acanthamoebic keratitis was observed in the 1980s, largely due to the wider spread of soft contact lenses and the use of non-sterile solutions for contact lenses. [4]Additional outbreaks in the late 1990s and 2000s were recorded in the United States and Europe and were epidemiologically linked to a number of possible sources, including pollution of municipal water supplies,  [5]regional floods [6]and the use of a widely available multi-purpose disinfectant solution for contact lenses. [7], [8]

As shown by a survey of patients, most of the diseased bathed in open water bodies (rivers, lakes, ponds, the sea). Apparently, water disinfection still reduces the number of bacteria and protozoa, without affecting only the microorganisms that are in the cyst stage. That's just the last and enter the body with tap water. And in a suitable environment, cysts go into the vegetative stage.

Other  ways of infection with a  unicellular parasite are not so relevant. For example, infection with acanthameba after surgery or injury is much less common (in about 4% of cases).

The eye is a very sensitive structure. It is not surprising that even the smallest speck of dust or cilia in the eye seems to us a great obstacle and causes very unpleasant sensations. Even the softest lenses, especially with careless or improper use, can become a traumatic factor for the cornea. Rubbing its surface and scratching it with adherent microparticles (when using poorly cleaning lens solutions) they facilitate the penetration of the infection deep into the eye, and tightly adhering to the eye, provide perfect contact between the cornea and pathogens that accumulate on the lens after interacting with the infected medium (in particular, with water). Akantameba appears to be “locked up” in conditions of ideal existence, where it subsequently parasitizes.

As for the epidemiological situation, it has improved significantly over half a century. For the first time, doctors faced an outbreak of the disease in 1973, when only 10 of the patients using contact lenses passed inflammation. Nowadays, keratitis is rarely diagnosed (4.2% of patients among those who have inflammatory eye diseases), but most patients go to doctors because of wearing lenses.

Thanks to a thorough study of the causes of the disease and the development of effective measures to prevent keratitis, doctors managed to reduce the incidence. But, despite the comforting statistics on keratitis, one should not forget that about 50% of hospitalizations and 30% of cases of vision loss are associated with inflammatory eye diseases.

Causes of the acantamebic keratitis

Given the ability of Akantameba to survive even in adverse conditions, we can say with confidence that this microorganism is part of our usual environment. No wonder we come across him everywhere. But why then the disease does not receive wide development?

And the reason is that nature has taken care of the natural protection of the eyes. It’s not easy for microorganisms to penetrate the cornea, so they are usually just transit passengers in the eye. But some negative factors can help the parasite infiltrate the structures of the eye, where it can linger longer and acquire offspring, while destroying the corneal tissue. These factors include:

• misuse of contact lenses,
• eye injuries
• corneal scratches or any other violation of its integrity, including surgical measures and postoperative care.

Akantameba does not need a host to exist at all, but this does not mean that it will not be able to harm the organs of vision, which are an ideal nutrient medium, containing substances of organic origin. [9]

Akantameb keratitis is an inflammation of the cornea, provoked by Akantameba, penetrating deep into the tissues of the eye or multiplying in the ideal environment that contact lenses create for it. It is not surprising that most patients with this diagnosis actively use lenses in everyday life. And, as it usually happens, they are not always able to adhere to the rules for the use and care of contact lenses. In this case, the disease can affect both one and both eyes.

Ophthalmologists consider the following risk factors for eye infection with acanthameba and the development of the inflammatory process in the cornea:

• bathing in contact lenses, especially in natural waters,
• improper lens care:
  • rinse with running water,
  • the use of tap water or non-sterile solutions for storing lenses,
  • improper disinfection of lenses or lack thereof,
• inadequate care (cleaning and disinfection) of the lens storage container,
• saving solutions for storing lenses (reuse, adding fresh solution to used one),
• non-compliance with hand and eye hygiene when using contact lenses.

Despite the fact that the last point seems to be the most likely factor of infection, it is more dangerous as one of the causes of bacterial keratitis. Akantamebny keratitis most often occurs in contact with water, i.e. As a result of bathing without removing contact lenses, or manipulating the lenses with wet hands. So, in the conditions of natural reservoirs, it is very difficult to observe the necessary hand hygiene when removing or installing contact lenses, in addition, there are not always conditions for their storage, so bathers prefer not to remove them. But this is a double-edged sword: caring for the preservation of the properties of lenses can be fatal to the eyes.

It has been established in the literature that wear of contact lenses is the strongest risk factor for the development of acanthamoebic keratitis, and the association of this disease and contact lenses is reported in 75–85% of cases. [10]

Previously reported correlation with herpes simplex keratitis,  [11],  [12]: about 17% of AK show the history of HSV eye disease or active co-infection with HSV. 

Pathogenesis

The pathogenesis of acanthamoebic keratitis includes parasite-mediated cytolysis and phagocytosis of the corneal epithelium, as well as invasion and dissolution of the corneal stroma. [13]

The disease belongs to the category of infectious and inflammatory, since the development of the pathological process is associated with a parasitic infection. The causative agent of the disease (akantameba) is a unicellular parasite, the usual habitat of which is water. Usually it is found in natural reservoirs, from where the parasite also enters tap water. But this does not mean at all that water in an artificial reservoir (pond or even a pool) can be considered absolutely safe, here you can also find akantameba, as well as in soil moistened with the same water.

The Acanthamoeba genus includes several types of free-living amoebas, 6 of which are dangerous to humans. These are aerobes living in soil and water, especially one that is contaminated with sewage. They can also be found in dust, where they fall after the ponds or soil have dried. In this case, microorganisms simply go into the stage of low activity (cysts) when they are not afraid of any temperature changes or disinfecting procedures.

Akantameba feel great in tap water and sewage, in the fluid circulating in the heating system and hot water supply. High water temperature only contributes to the multiplication of microorganisms.

Water containing microorganisms may get into your eyes while bathing, washing, and contacting your eyes with wet or dirty hands. But in itself, the ingestion of water or soil infected with parasites into the eyes does not cause illness. Moreover, acanthamoeba can be found in healthy people (in the nasopharynx and feces).

Our eye is designed in such a way that the lacrimal glands present in it contribute to the physiological hydration and cleansing of the cornea. Dust and microorganisms falling on it through the drainage systems of the lacrimal apparatus are removed into the nasopharynx cavity, from where together with the mucus they are removed. The parasite simply does not have time to “settle down” in the eye and begin to multiply actively.

If there is a violation of the drainage function, acantameba not only conveniently settles in an ideal environment (warm and humid), but also begins to multiply actively, provoking diffuse inflammation of the cornea.

Symptoms of the acantamebic keratitis

Acanthamoebic keratitis is an inflammatory eye disease that cannot do without the symptoms inherent in this process: redness of the eyes, foreign body sensation and associated discomfort in the eye, pain (a frequent inflammation companion), which intensifies when contact lenses are removed. They can be considered the  first signs of  corneal inflammation, although many other eye diseases, including a mote in the eye, have the same manifestations. Further, patients may complain of causeless tears that flow beyond the will of a person, pain in the eyes, deterioration in clarity of vision (as if a film were in front of the eyes). [14]

All these symptoms are similar to the sensations when a small speck enters the eye, but it will not work to “blink” in this case. The clinical picture is notable for its persistence, but as inflammation  develops, the symptoms of acanthamoebic keratitis  tend to intensify. At first, only discomfort after an eyelid is felt, then soreness and, finally, sharp cutting pains as with an open wound, provoking and exacerbating lacrimation.

But it should be noted that a sharp onset of the disease or rapid progression of inflammation is noted in no more than 10% of patients. In others, the disease is characterized by a slow but not mild course.

Regardless of the cause of inflammation, keratitis manifests itself as a specific symptom complex, which doctors call the corneal syndrome. It is characterized by:

• sharp severe pain in the eye,
• increased lacrimation,
• convulsive contraction of the circular muscle of the eye, which leads to involuntary closure of the eye (blephospasm),
• painful reaction of the eyes to bright light (photophobia).

This syndrome is specific and helps to differentiate the inflammation of the cornea from conjunctivitis before analyzing the pathogen of inflammation.

In the advanced stage, if the treatment of inflammation was not carried out or was inadequate, one can notice clouding of the cornea (a violation of its transparency is one of the characteristic signs of keratitis), the formation of a bright spot on it (eyesore), a noticeable visual impairment up to blindness. In some cases, a purulent ulcer forms on the cornea, which indicates the introduction of infection into the deep tissue of the eye.

Complications and consequences

Once again, the tissues of the organ of vision are highly sensitive, which is why they react so sharply to any negative conditions. In fact, this complex optical structure is very tender and subject to degenerative changes. The inflammation that occurs in the cornea is difficult to treat, while the long-lasting inflammatory process is easily able to change the properties and functionality of the organ.

Acanthamoebic keratitis is a disease with severe unpleasant symptoms that cause significant discomfort and worsen the patient's quality of life. Is it easy for you to do the previous work if a speck flies in the eye and irritates it? All thoughts immediately switch to how to remove it. But with inflammation of the cornea, such amulets are amoebas, which are not so easy to remove from the eye, therefore painful symptoms torment a person constantly, sometimes weakening, then collapsing with renewed vigor.

It is clear that this state of affairs will affect a person’s ability to work and his mental state. Pain-related impaired attention combined with visual impairment can be an obstacle to fulfilling one's labor obligations. Spontaneous closing of eyes and poor eyesight increase the risk of domestic and industrial injuries.

These are the consequences of keratitis of any etiology, if the patient does not seek professional help or is self-medicating, not understanding the cause and mechanism of the disease. But there are also complications that can arise both in the absence of treatment, and with the incorrect selection of effective therapeutic methods, which often becomes the result of incorrect diagnosis. Still, keratitis of various etiologies require their own, unique approach to treatment.

The most common complication of the inflammatory process in the cornea is its clouding. Long-term inflammation causes cicatricial changes in the tissues of the eye and it is not always possible to achieve complete resorption. In some cases, changes in the transparency of the cornea progress with the formation of a local bright spot (eyesore) or a general decrease in vision in one eye, up to complete blindness in the future. [15]

Any inflammation is a breeding ground for a bacterial infection, which nothing prevents to join the parasitic. In this case, inflammation can also cover the deepest structures of the eye, provoking the development of purulent inflammation of the inner membranes of the eyeball (endophthalmitis), as well as inflammation of all the membranes and media of the eye (panophthalmitis).

Against the background of reduced immunity, the addition of herpevirus infection is not uncommon.

The deeper the inflammation, the more severe the consequences can be expected. It is not always possible to maintain vision and aesthetic appearance of the eye, quite often the disease recurs after seemingly effective therapy, so doctors sometimes resort to surgical treatment, which consists in replacing (transplanting) the cornea.

Acanthamoebic keratitis, like any inflammation of the cornea, has 5 degrees of severity (stages):

• superficial epithelial lesion,
• superficial punctate keratitis,
• stromal annular,
• ulcerative (with the formation on the cornea of wounds)
• scleritis (inflammation extends to the sclera)

The first 2 stages are treated with medication. But treatment does not always give good results. With the progression of the disease, surgical treatment in combination with medication is indicated.

Diagnostics of the acantamebic keratitis

Discomfort and pain in the eye sooner or later force patients to seek help from specialists. And then it turns out that the cause of the pain and visual impairment was not contact lenses and dust sticking to them, but protozoa that once settled in the tissues of the eye due to the carelessness of a person. But in terms of the patient’s appearance, it’s difficult for a doctor to say what causes redness of the eyes, pain and tearing, because these symptoms are also present in other diseases. Redness and pain in the eyes in combination with photophobia are noted even with flu, not to mention eye diseases. [16]

Only an expert (ophthalmologist) can make an accurate diagnosis, to whom the patient is referred. An indicator of the inflammatory process for this doctor will be the very fact of corneal clouding caused by the accumulation of leukocytes, lymphocytes and other small cellular elements, the level of which increases with inflammation.

But clouding of this part of the eye can also cause degenerative-dystrophic changes, so it is important for the doctor to determine whether inflammation is occurring and what it is associated with. A thorough description of the patient’s symptoms and anamnesis will help him in this: does the patient wear contact lenses, how does he care for them, does he take off during bathing, have there been any eye injuries, etc.

Instrumental diagnosis of  acanthamoebic keratitis usually comes down to one basic method - eye biomicroscopy, which is a non-contact study of various structures of the eye using special equipment. During the study, a microscope and various illumination options are used, which help to visualize even those structures of the complex optical system of the eye that are not visible under ordinary lighting. [17]

In modern clinics, ultrasound biomicroscopy (contact using anesthetic and non-contact method) is increasingly used. In any case, the doctor receives reliable information about the different structures of the eye, their condition, the presence of inflammation, its nature and prevalence. Biomicroscopy can detect the disease even in the early stages, when the symptoms are not yet expressed.

But detecting corneal inflammation is only half the battle. It is important to determine the cause of the disease. But this often causes problems. Differential diagnosis of  bacterial, viral, allergic, fungal and other types of keratitis is quite difficult. High risk of inadequate diagnosis.

Specific tests help determine the cause of the disease or exclude its various options . A blood test will help identify inflammation, but no more. But microbiological studies can give an answer about the causative agent of the disease. To this end, carry out:

• bacteriological examination of material taken during the corneal scrapings (often by polymerase chain reaction (PCR)  [18], [19]
• cytological examination of the epithelium of the conjunctiva and cornea,
• allergens with different antigens
• serological studies based on the interaction of antigens and antibodies.

But the problem is that the diagnosis of “acanthamoebic keratitis” is often made by the absence of signs of other pathogens, and not by the presence of cysts and active individuals of acanthameba. Laboratory studies do not always provide an opportunity to accurately answer whether there are protozoa in the tissues of the eye or whether they are not there.

Recently, a specific method of confocal laser scanning microscopy, which has excellent contrast and spatial resolution, has gained increasing popularity. It makes it possible to identify the causative agent of the disease and its cysts in any of the layers of the cornea, to determine the depth and prevalence of eye damage. This allows you to make a diagnosis with maximum accuracy, eliminating diseases with similar symptoms.

Treatment of the acantamebic keratitis

Since the inflammatory process in the structures of the eye can be caused by various reasons, a doctor can prescribe effective treatment only after he makes sure that the diagnosis is correct. But often diagnostic errors are detected after a time when the prescribed course (most often antibiotic therapy due to suspected bacterial nature of the disease) does not give results. The drugs used must be effective against protozoa, not just bacteria, i.e. The selection of antibiotics and antiseptics should not be random by analogy with conjunctivitis.

By the way, this problem is often encountered in self-medication, because people have limited knowledge of eye diseases, so patients attribute all symptoms to conjunctivitis, not taking into account the pathogen. So, they also try to carry out the treatment with medicines that were once prescribed for conjunctivitis. Often this only exacerbates the situation, because time does not play into the hands of the patient. In addition, patients often continue to wear contact lenses, which cannot be done.

So, the treatment of acanthamoebic keratitis begins with an accurate diagnosis and refusal to wear contact lenses at least for the duration of treatment. Mild forms of the disease, detected at an early stage, are treated on an outpatient basis. Inpatient treatment is indicated for severe and complicated forms of keratitis. In these same cases, the possibility of surgical treatment is considered (layered superficial and deep keratoplasty, end-to-end keratoplasty, phototherapeutic keratectomy).

In mild cases, they cost medication aimed at destroying the causative agent of the disease (acanthameba and its cysts) and restoring corneal tissue. For these purposes, apply eye drops, ointments, instillations of drugs and medicinal films containing antibacterial (antiprotozoal), anti-inflammatory, and sometimes antiviral (if herpes infection joins) components.

To combat the causative agent of the disease, complex treatment with antibiotics and antiseptics is used, since there is currently no specific single drug active against acanthameba. Most often, a combination of chlorhexidine (in the form of instillations) and polyhexamethylene biguanide is used (included in Optifree contact lens care solution, which is used to instill eyes, and Comfort Drops moisturizing eye drops). This complex is effective both against the active forms of the amoeba and against its cysts. Biguanides are the only effective therapy for in vitro and in vivo resistant encysted body forms. The use of modern steroids is controversial, but probably effective, in treating severe inflammatory complications of the cornea that were not effective in treating biguanides. Acanthamoeba scleritis is rarely associated with extracorneal invasion and is usually treated with systemic anti-inflammatory drugs in combination with topical biguanides. Therapeutic keratoplasty can be used in the treatment of some severe complications of acanthamoebic keratitis. [20]

In more severe cases, with a complicated course of the disease and in the absence of the effect of specific therapy, such drugs are additionally prescribed:

• antiseptic drops “Vitabact” based on picloxidine or “Okomistin” based on miramistin,
• diamedins (propamidine - a substance with a pronounced bactericidal and antiprotozoal effect, is part of imported eye drops, for example, the drug "Brolene"),
• antibiotics from the group of aminoglycosides (neomycin, gentamicin) and fluoroquinolones (there is information about the high effectiveness of the antimicrobial drug from the group of fluoroquinolones based on Vigamox moxifloxacin in the form of eye drops),
• polypeptide antibiotics (polymyxin),
• mycostatics (fluconazole, intraconazole),
• iodine preparations (povidone-iodine),
• anti-inflammatory drugs:
  • NSAIDs (for example, “Indocollyr” drops based on indomethacin - anesthetizes and relieves inflammation) are prescribed rarely and in a short course,
  • corticosteroids, for example, dexamethasone, are used mainly after surgery or in the non-acute period of the disease, since they can provoke activation of the disease, antiglaucoma drugs are prescribed in combination with them (for example, Arutimol, which normalizes intraocular pressure),
• mydriatics (these drugs are prescribed both for diagnostic purposes for dilating the pupil and also for the treatment of inflammatory eye diseases),
• preparations with a regenerating effect (Korneregel, Lipoflavon, Tauforin),
• artificial tear installations
• vitamins, biogenic stimulants.

Visual acuity reduction is also treated using physiotherapeutic procedures: electrophoresis, phonophoresis with enzymes, ozone therapy, VLOK.

There are different approaches to the  treatment of acanthamoebic keratitis, the drugs and treatment regimen are prescribed individually, based on the diagnosis, stage and severity of the disease, the presence of complications, the effectiveness of the therapy, etc.

Medication

Practice shows that the usual broad-spectrum antibiotics are effective in the complicated course of acanthamoebic keratitis, but they do not have a destructive effect on acanthameb. Antiseptics, especially chlorhexidine, and a disinfectant, which is part of the eye drops and contact lens care solution, have a more pronounced bactericidal effect. Using the Opti-fri solution, it is possible to avoid a disease dangerous to eyes. [21], [22]

As for antiseptics, the drug Okomistin in the form of eye drops was widely used in the treatment of inflammatory eye diseases. Its active substance - miramistin - is active against a large number of bacteria, fungi, protozoa, in addition, it increases the sensitivity of pathogens to more powerful antimicrobial agents.

For the treatment of keratitis, Okomistin is used in combination with antiprotozoal agents and antibiotics. The drug is prescribed for adults and children 4-6 times a day. It is instilled with a conjunctival sac of the eye for 1-2 (for children) and 2-3 (for adults) drops with a course of no more than 14 days.

The medicine is also used in the postoperative period: 1-2 drops three times a day for up to 5 days, and also for preparation for surgery (2-3 drops three times a day for 2-3 days).

The only contraindication to the use of an antiseptic is considered to be hypersensitivity to its composition.

The use of the drug is rarely accompanied by discomfort (a slight burning sensation that disappears within a few seconds). This side effect is not dangerous and is not a reason for stopping therapy. But hypersensitivity reactions require drug withdrawal and treatment review.

Okomistin is often used in combination with local antibiotics.

No less popular in the  treatment of acanthamoebic keratitis  and the Vitabact antiseptic based on picloxidine, a biguanide derivative that is considered active against a large number of infections, including and protozoal.

A medicine is available in the form of eye drops. It is usually prescribed 1 drop 3-4 times a day (up to 6 times) in a ten-day course. Before eye surgery, it is also recommended to introduce 2 drops of the solution into the conjunctival sac.

The drug is not prescribed for intolerance to its components, hypersensitivity to biguanides. When lactating during the use of the drug, the child is better not to breastfeed. The use of the drug is  also undesirable  during pregnancy.

When instilling the solution into the eyes, burning sensation can be felt, local hyperemia is noted, which does not require treatment.

Brolene eye drops with propamidine are a good alternative to the combined treatment with Comfort Drops and chlorhexidine or another antiseptic. Propamidine reduces the activity of pathogens, inhibits their reproduction, so it is easier to remove them from the eye with the help of instillations.

The solution is injected into the eye 1-2 drops up to 4 times a day.

Drops are not recommended for pregnant women and nursing mothers, as well as for patients with hypersensitivity to the components of the drug.

The use of the drug is painless, but blurred vision may be felt for some time. During this period, it is better to refrain from performing potentially dangerous actions. If vision becomes worse or the symptoms of the disease worsen, you should consult your doctor.

"Indocollyr" is a non-hormonal drug with anti-inflammatory and analgesic effects. It is prescribed mainly after eye surgery, but can also be used in complex drug treatment without surgery.

Prescribe the medicine 1 drop 3-4 times a day, including the day before the operation (this reduces the risk of complications).

The drug is relevant for severe pain. But it has a number of serious contraindications: hypersensitivity to the drug, a history of “aspirin” asthma, stomach and duodenal ulcer, severe liver and kidney pathologies, the second half of pregnancy, and breast-feeding. The medicine is not used in pediatrics.

"Indocollyr" belongs to the category of NSAIDs, which due to their effect on the blood inhibit the regenerative processes in the cornea, therefore it is not recommended to use it for a long time or without a doctor’s prescription.

The use of the drug can cause side effects from the eyes: redness, itching, slight burning sensation, temporary deterioration of vision, increased sensitivity to light. True, such complaints from patients are rare.

Korneregel is an ophthalmic gel preparation based on dexpanthenol. It promotes the regeneration of the mucous membranes of the eye and the skin around them, easily penetrating deep into the tissues. Actively used in the treatment of keratitis of various etiologies.

The gel is applied topically, taking into account the severity of the disease. Start with 1 drop 4 times a day, plus 1 drop before bedtime. Lay the gel in the conjunctival sac.

The duration of treatment is purely individual and is determined by the doctor depending on the observed therapeutic effect. It is advisable not to use the drug often and for a long time due to the preservative in the gel, which causes irritation and even damage to the mucosa. When used in combination with other eye drops, gels, ointments, the interval between the use of drugs should be at least 15 minutes.

Among the contraindications to the use of Korneregel, only hypersensitivity to dexpanthenol or any other component of the drug is indicated.

Among the side effects, hypersensitivity reactions are predominantly indicated, accompanied by itching, redness, skin rashes, and eye symptoms. The latter include redness, burning, sensation of a foreign body, pain, lacrimation, swelling.

"Lipoflavon" is a wound healing and regenerating agent based on quercetin and lecithin. It has antioxidant properties, is effective against viruses, inhibits the production of inflammatory mediators, improves trophic tissue of the eye.

The drug is produced in the form of a powder in a vial, to which a sterile vial with a 0.9% sodium chloride solution (saline) and a dropper cap are attached. It is used for instillations of keratitis of various etiologies in the form of eye drops, as well as in the postoperative period. The medicine reduces the risk of keratitis due to damage to the cornea during surgery.

When used in ophthalmology, saline is added to the bottle with powder, shaken well until completely dissolved and put on a dropper cap. Drop the medicine into the conjunctival sac, 1-2 drops up to 8 times a day. The number of instillations is halved when the inflammation subsides. The course of treatment usually lasts from 10 to 30 days.

The drug has contraindications: hypersensitivity to the composition, allergic reactions to protein and vaccines in the anamnesis, alcohol consumption. During pregnancy and lactation, Lipoflavon is used only with the permission of the doctor due to the lack of data on the effect of the drug on the fetus and the course of pregnancy. Used in pediatrics since 12 years.

Among the side effects with topical application, only allergic reactions are possible (itching, skin rashes, fever).

Since the eye is a very sensitive organ, it is not recommended to use any of the drugs without a doctor’s prescription. If the doctor prescribes to instill both eyes, even if only one is affected, its appointment must be performed, since there is a high probability of transmission of the infection, activation of the virus living in the body, etc.

The use of alkylphosphocholines may be a new treatment. These are phosphocholines esterified into aliphatic alcohols. They exhibit antitumor activity in vitro and in vivo, and they have been shown to be cytotoxic to Leishmania, Trypanosoma cruzi and Entamoeba histolytica species. A recent study showed that especially hexadecylphosphocholine (miltefosine) is also very effective against various Acanthamoeba strains. [23], [24]

Alternative treatment

Doctors consider acanthamoebic keratitis a serious eye disease, because with the wrong approach to treatment, the disease can progress and lead to blindness. Alternative methods of treating corneal inflammation are not a substitute for traditional drug therapy, but can only complement it, removing painful symptoms. In addition, given the fact how delicate the structure of our eyes is, it is highly not recommended to instill dubious solutions into it. Any prescription should first be discussed with your doctor.

Plants and products used in alternative treatment are not able to destroy the pathogen, but can reduce pain and discomfort, relieve hypersensitivity to light, relieve redness and swelling of the eyes, and help restore damaged tissues. But you must use the proposed recipes consciously, carefully assessing the possible risks.

What do alternative healers offer us with keratitis?

• Sea buckthorn oil. This is an excellent source of vitamins for the eyes, which also has a regenerative effect. It is not much better to take sterile, it is sold in pharmacies. Drop 2 drops in a sore eye. The interval between procedures is from 1 to 3 hours.

The tool reduces pain, relieves photophobia, helps restore corneal tissue. But no need to expect a miracle from him. Oil is neutral against the causative agent of the disease, therefore, in parallel with it, antiprotozoal and antiseptic agents must be used.

• Propolis aqueous extract (1 part) and celandine juice (3 parts). The composition is used in the form of eye drops for bacterial complications of keratitis. The recommended dose is 2 drops in the eye at night.
• Clay. Used for lotions, relieves pain. Wet clay is placed on a napkin with a layer of about 2-3 cm. A bandage is applied to the eyes for an hour and a half.
• Liquid honey. One part of May honey is mixed with 3 parts of warm water and stirred to make the liquid clear. Use a tool to instill or rinse the eyes 2 times a day.

Honey is a strong allergen, therefore, with an allergy to beekeeping products, such treatment can only increase inflammation.

• Aloe. The juice of this plant has remarkable regenerative properties, is an excellent antiseptic. Its use will help prevent bacterial and viral complications of keratitis. At the beginning of the disease, aloe juice is used by adding a few drops of the mummy, and then in its pure form (1 drop per eye).

It is also used in case of keratitis and  herbal treatment, which helps to increase the effectiveness of drug therapy and prevent complications.

The eyeball has a beneficial effect on the eye. A liquid medicine is made from it, which is used internally and for instillation of the eyes. To prepare the infusion for internal use, take 1 tablespoon per liter of boiling water. Chopped herbs and insist in heat for at least 6 hours. Treatment is carried out three times a day, taking ½ cup of infusion.

Eye drops are prepared by taking 1 tsp. Herbs in a glass (200 ml) of water. The composition is boiled for 3 minutes, after which it is removed from the heat and insisted for another 3 hours. A strained broth is instilled into the eyes (2-3 drops) before bedtime.

For compresses and lotions, decoctions of clover flowers (20 g of grass per 1 / tbsp of water, boil for 15 minutes) and calendula (1 tsp for 1 tbsp of water, boil for 5 minutes) are used, which have antimicrobial and anti-inflammatory effects. The compress from the clover decoction is put on for half an hour, and calendula lotions - for 10-15 minutes. The procedure is carried out twice a day. Treatment is carried out until the symptoms of the disease disappear.

For washing the eyes, it is useful to use chamomile infusion. Since the use of anti-inflammatory drugs with acanthamoebic keratitis is limited, chamomile is a real find, because it does not cause unwanted side effects.

To prepare the infusion, you need to take 2 tbsp. Dry flowers and pour them with 2 cups boiling water. The medicine is infused for 15-20 minutes or until completely cooled under the lid.

Eye washings can be carried out 3-4 times a day. Additionally, the infusion can be used for lotions.

When preparing at home the means for burying and washing the eyes, you need to remember about sterility. It is better to take purified water, thoroughly boil the dishes. Devices for eye instillation should also be sterile: droppers, pipettes. Otherwise, it is not difficult to enter a bacterial infection in the acanthamoeba infection.

When digging in the eyes, try to prevent the dropper from touching the tissues of the eye. When washing eyes, it is important to use a separate bandage or cotton pad for each eye, changing them as often as possible during the procedure.

Homeopathy

With a disease such as acanthamoebic keratitis, even treatment with alternative agents may seem dubious, not to mention homeopathy. However, homeopaths insist on the beneficial effects of certain drugs of this kind. And I must say that their arguments are very convincing.

Acanthamoebic infection is one of the types of infection process. The causative agent of the disease is a protozoal infection, namely acantameb. If you go the traditional way, then the identification of the causative agent of the disease using laboratory tests can be considered as a long process. PCR analysis of samples of corneal epithelium and lacrimal fluid allows one to isolate amoeba DNA even with a minimal content, but this requires a lot of time.

Scraping staining with different methods does not always give accurate results that require professional interpretation. The histochemical method is relevant in the more severe stages of the disease, but at first it can give a negative result and cysts can only be detected with a biopsy.

The maximum speed of obtaining the actual result is shown by the method of confocal microscopy, but it is not yet used in all clinics. So in most cases, to clarify the diagnosis, in order to start effective treatment, it takes several days, or even weeks.

All this time, inflammation will progress, which negatively affects the functionality of the cornea. Homeopaths offer a good way out - to begin treatment with anti-inflammatory and regenerative agents immediately after a patient visits a doctor. Moreover, homeopathic remedies used, unlike corticoids and NSAIDs, will not potentiate or aggravate inflammation.

Among the homeopathic medicines used for any type of keratitis, a special role is given to Mercurius corrosivus, which is often prescribed for sharp tearing pains in the eyes at night, photophobia, and the appearance of deep ulcers on the cornea.

With burning pains in the eyes and copious discharge, homeopathic remedies such as Mercurius solubilis (relevant in the initial stages of the disease), Pulsatilla, Brionia, Belladonna, Aurum, Arsenicum album, Apis, Aconitum, etc. Showed themselves quite well.

With ulceration, homeopaths also prescribe Hepar sulfur, Kali bichromicum, Kali iodatum, Konium, Rus toxicodendron, Syphilinum, Calcarea. With chronic keratitis and severe clouding of the cornea Sulfur.

Many of these drugs help relieve pain and cope with increased eye sensitivity to light. Almost all of them are assigned in small breeding.

Prescribe drugs inside of 3-6 granules under the tongue 20-30 minutes before meals several times a day. And this is not about monotherapy, but about the use of homeopathy preparations in parallel with the classical medications prescribed for keratitis with the exception of antibiotics. The latter makes sense to appoint when the causative agent of the disease is specified.

Homeopaths today are in active search for effective comprehensive remedies for the treatment of keratitis (before the introduction of antibiotics and in combination with them). One of the innovative developments is considered to be a drug based on such components: Mercurius corrosivus, Belladonna, Apis, Silicea (all of them have one C3 dilution). Conium can also be added to it.

Both versions of the drug reduce pain during the first 2 hours. Also decreases the sensitivity of the eyes to light, lacrimation. The next day, the symptoms are almost not felt.

The developers of the drug, which has no name yet, claim that this complex medicine is universal, does not cause allergic reactions, does not enter into dangerous interactions with medicines, has no side effects and age restrictions. It can be prescribed by both homeopaths and doctors who do not have special training.

It is clear that it is impossible to cure acanthamoebic keratitis with it, but to alleviate the patient’s condition and slow down the pathological process for a while while the diagnosis is able to cure the disease and treat the disease.

Prevention

Any serious illness is easier to prevent than to treat, especially when it comes to parasites, effective drugs against which there is virtually no. But here there are certain difficulties. The fact is that Akantameb cysts are resistant to disinfection. They can be destroyed by chlorination of water, but the concentration of chlorine in this case will far exceed the permissible standards. So, as they say, the salvation of drowning people is the work of the drowning themselves. ”

But acanthamoeba are also scary because, according to the latest research of scientists, they can become carriers of bacterial infection, which inside the parasite is protected from disinfectants.

Nevertheless, acanthambic keratitis is a rather rare disease today, which means that protecting your eyes from amoeba and avoiding loss of vision is not so difficult. Among the most effective preventive measures are:

• Proper care of contact lenses, the use of high-quality sterile solutions for their storage, the use of only licensed lenses.
• Maintaining hand hygiene when handling lenses in the eye area, eye hygiene.
• When taking a shower, washing, bathing in any aqueous media, contact lenses must be removed and placed in specialized solutions. If water gets into your eyes, it is better to rinse them with a solution of the type "Opt-free" or "Comfort Drops". Such eye care can reduce the likelihood of infection with Akantameba.
• Every 3 months it is recommended to replace the contact lens container.
• You should regularly visit an ophthalmologist (at least once every six months), even if there would seem to be no reason for this. If the patient feels discomfort, burning, pain in the eyes, it is definitely not worth postponing a visit to the optometrist.

Acanthamoebic keratitis is a dangerous disease that can deprive a person of vision, i.e. That valuable functionality, thanks to which we perceive the largest part of information about the world around us. Such a disease should not be taken carelessly, putting off going to the doctor for later. Timely diagnosis and treatment, as well as prevention, can preserve eye health and the happiness of seeing the world with your own eyes.

Forecast

The opinion of acanthamoebic keratitis as one of the most dangerous and insidious eye diseases among doctors is the same. This disease is difficult to treat, traditional antibiotics are often ineffective. With the insufficient effect of drug treatment of this slowly progressing pathology, phototherapeutic keratectomy is considered the most optimal treatment method. If there is a deep lesion of the cornea to save the eye, keratoplasty cannot be dispensed with. [25]

The prognosis of surgery is largely dependent on the depth of the cornea and the age of the patient.

Acanthamoebic keratitis in the absence of effective treatment becomes chronic with periods of remission and exacerbation (depending on the life cycle of protozoa). At the same time, the cornea gradually turns pale, ulcers appear on it that attract a bacterial infection, and vision deteriorates. With strong perforation of the cornea, the underlying structures may be involved in the process, which is an indication for eye removal (enucleation).

In general, the prognosis for acanthamoebic keratitis depends on several factors:

• Timely diagnosis and correct diagnosis,
• The adequacy of the treatment
• Dates of surgical procedures,
• The effectiveness of subsequent treatment with corticoids and immunosuppressants.

There is an opinion that at the stage of diagnosis, acanthamoebic keratitis should be suspected in all patients using contact lenses. This is especially true if the inflammation is spasmodic with pronounced periods of exacerbation and remission.