Acanthamoeba keratitis is a sight-threatening corneal infection that demands prompt, structured intervention. Establishing an accurate diagnosis alongside immediate treatment initiation is central to this protocol.

Approach

This first-line protocol opens with diagnostic epithelial debridement for culture and staining, followed immediately by an intensive topical dual-agent regimen applied on a defined schedule with a structured tapering phase.

The specific agents, concentrations, dosing intervals, and tapering sequence are available in the full structured regimen below.

Clinical Goals

The aim is clinical control of the keratitis. Response to therapy — particularly in established infections — can take up to 2 weeks to be appreciated. For disease limited to the epithelium, the protocol defines a specific timeframe after which therapy may be discontinued.

References

Initial therapy for Acanthamoeba keratitis should begin with diagnostic epithelial debridement for culture and staining followed by immediate topical therapy (Table 1).
Topical dual therapy should start with chlorhexidine 0.02% and propamidine 0.1% every hour around the clock for 2-3 days.
Following this, the treatment can be reduced to waking hours only for approximately 3 days.
Therapy is then tapered to 4 times a day.
Realizing that response to therapy, especially in established infections, can take 2 weeks to be appreciated, therapy may be reduced to every 4 hours while awake once control is established.
For disease limited to the epithelium, therapy may be discontinued after 2-4 weeks.

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What Is the First-Line Treatment for Acanthamoeba Keratitis?

References