Ocular Hypertension, Glaucoma Frequent Complications of Acanthamoeba Keratitis

Optometrist Eye Exam Tonometer
Optometrist examines the eyes of a young woman patient with a tonometer.
Patients with Acanthamoeba keratitis could benefit from vigilant glaucoma monitoring, researchers suggest.

Ocular hypertension (OHT) and glaucoma are frequent complications in Acanthamoeba keratitis (AK), according to findings published in Eye & Contact Lens.

Researchers conducted a retrospective review to determine the incidence of OHT and glaucoma in patients with AK and to outline the risk factors for developing glaucoma. The study included 52 eyes diagnosed with AK between 2000 and 2018. The study found a 51.9% incidence of OHT and a 32.7% incidence of glaucoma. The mean duration from disease onset to the first attack of elevated intraocular pressure (IOP) was 8.4±16.6 months. There was a significant association between the use of corticosteroids in the treatment regimen and the development of glaucoma (P =.049). Patients with and without glaucoma had improved visual acuity without a difference in the mean amount of logarithm of the minimum angle of resolution acuity improvement among them at follow up (P =.69). 

Researchers highlight the fact that documentation of disc damage or visual field defect was required for a diagnosis of glaucoma. 

“Given that patients with AK may present with corneal opacification that precludes view to the optic nerve head and prevents proper visual field testing, some of the patients classified as OHT may have had glaucoma,” according to the researchers. 

The study outlines some of the mechanisms that can account for glaucoma in AK patients, which include steroid response, granulomatous anterior chamber inflammation, peripheral anterior synechiae leading to secondary angle closure, elevated episcleral venous pressure, and impaired outflow caused by cysts. The first instance of elevated IOP was documented during follow up in all patients, which suggests that “glaucoma might have occurred because of sequelae of the diseases and/or treatment (i.e., peripheral anterior synechiae formation or steroid response) rather than the inflammation associated with the disease process.”

Study limitations include its retrospective nature, possible confounding, and its single center design.


Al Owaifeer AM, Al-Omair S, Alrefaie S, Alenezi SH, Al-Shahwan S. Incidence and risk factors of ocular hypertension and glaucoma in patients with acanthamoeba keratitis. Eye Contact Lens. 2021;47(11):588-591. doi:10.1097/ICL.0000000000000824.