Contact lens-related combined Pseudomonas aeruginosa, Acanthamoeba and Candida keratitis among adolescents girls

Background: We present a case of combined Pseudomonas aeruginosa, Acanthamoeba and Candida keratitis and clinical course of treatment in two adolescents girls who did not follow the rules of proper use of soft contact lenses. Case reports: Two teenage contact lens users sought medical attention, reporting visual impairment, redness and pain of the eye. Slit lamp examination showed unilateral corneal ulcer. Confocal microscopy revealed images compatible with amoebic cysts and yeasts cells, whereas the results of conjunctival swabs confirmed the presence of Pseudomonas aeruginosa. After topical and general treatment in the first patient, the corneal defect was healed, and visual acuity improved. The girl remains under the constant supervision of an ophthalmological clinic. The medications were gradually reduced, but with time she developed crystalline keratopathy. Regrettably, the second patient, despite the applied treatment had recurrent inflammation and progressive corneal thinning, which required amniotic membrane transplantation to prevent perforation. Conclusion: The early identification of the pathogen as well as adequate treatment is crucial, as contact lens-associated keratitis are potentially sight threatening. Patient and caregiver education, adequate contact lens hygiene and consistent follow-up are important to prevent serious complications.