corneal ulcer due to amoeba infection

[James1105]

My daughter (13 yrs old) started feeling pain in her right eye on 12/5 (Sunday). The next day we took her to see an eye MD who initially though it was due to bacterial infection and gave us antibiotics. On 12/7 the infection seems to be worse, and she gave us stronger anibiotics (Vigamox). The next day (12/8) things seemed to be under controlled, but on 12/9 morning new lesion was seen. She told us that it might be amoeba infection, although she has never seen amoeba infection that progress so rapidly. We immediately started standard anti-amoeba treatment: Brolene (q1h) and PHMB (q2h) around the clock. On the night of 12/9 the lesion progressed so rapidly that she suggested us to go to a local hospital to see a corneal specialist, and there a corneal smear and debridement were performed. The next day the hospital called to tell us that amoeba cysts were observed in the smear sample. On 12/13 we went to a hospital to have a confocal microscope scan and they found small round things that look like amoeba cysts. We continued on the intensive treatment for almost a week (12/9~12/16) and the infection is now under controlled and our doctor is reducing the dosage: Brolene (q2h) and PHMB (q2h) when she is awake, no instillation while she is in bed. My questions are followings:
(1) our eye MD said the infection is relatively superficial. But, there is sever opacity (what cloud) in the upper 1/3 of the stroma. The opacity is so sever that her vision is completely blocked. Will this opacity (swelling??) fade away? How long does it take? Is there anything we can do to speed up the healing and minimize the scarring?
(2) The epithelium wound (due to lesion and debridement??) is not completely healed so far. Is this prolonged healing normal?

Many thanks from a very worried father, please help!!

[James1105]

Dear Dr. Oyakawa,

Thank you for your prompt reply. Unfortunately, the opacity cloud involve the visual axis. But, our opthamologist said the opacity should slowly fade away once the epithelium defect heals. Is this true?

Many thanks!!

[Ray T Oyakawa, MD]

You discuss the prognosis with your doctor.  This is a very serious condition and a corneal transplant may be needed if the scaring involves the visual axis.

Dr. O.