What does the picture show? Answer Multiple acanthamoeba cysts. The cysts are double-walled with a wrinkled outer wall called the exocyst and a smooth inner wall called the endocyst. a How may the patient present? a Answer Severe ocular pain which is generally out of proportion to the slit-lamp finding. Initially the patient may present with dendritic ulcer which may be misdiagnosed as herpes simplex keratitis. Other early signs are radial keratoneuritis and non-specific stromal keratitis. Ring infiltrate which is the hallmark of acanthamoeba can develop later in the course of the disease. Corneal necrosis can develop in advanced cases.
