Acanthamoeba species can cause a chronic, progressive, ulcerative keratitis of the eye, which is not responsive to the usual antimicrobial treatment and is frequently mistaken for stromal herpes keratitis. Acanthamoeba keratitis continues to be a burgeoning and unsolved problem. Although soft contact lens wear is reported as the major risk factor in other parts of the world, reports from India suggest that acanthamoeba keratitis is more common among non-contact lens wearers. An unusual case of coinfection with Acanthamoeba and methicillin resistant staphylococcus aureus (MRSA) as causes of corneal keratitis in a contact lens wearer from Kashmir, India, is reported. Recent findings have shown that MRSA uses amoebae to spread, sidestepping hospital and other protection measures. Cysts of the isolated Acanthamoeba tolerated an incubation temperature of 40°C, indicating a pathogenic species. This case highlights the importance of culture methods in the diagnosis of corneal infection and the choice of treatment regimen.

A 22-year-old man complained of sudden, painless loss of vision (vague scotoma in central vision) in his right eye. The patient became symptomatic following a session of weight training at a gymnasium the previous day. There was no history trauma. Medical, ocular and familial history were unremarkable. The inferior and temporal aspect of the haemorrhage was darker due to gravitation, but the rest of the fundus was normal. The appearance of the right fundus, combined with an associated unequivocal history of physical exertion, was consistent with a diagnosis of Valsalva maculopathy (holding breath while bench pressing). Systemic examination and all relevant blood tests were normal. Fluorescein angiography (FFA) was done which confirmed the diagnosis. The patient recovered a vision of 6/6 in his right eye after 2 months. FFA was again done, which showed no sequelae of the problem.