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The role of topical corticosteroids in management of  Acanthamoeba  keratitis (AK) remains controversial. Using a rabbit AK model, we investigated whether corticosteroid use is a risk factor of AK.  Acanthamoeba  (1 × 10 5 /ml) was incubated with two densities of  P .  aeruginosa  (PA; high-PA: 1 × 10 8 /ml, low-PA: 3 × 10 5 /ml) before corneal inoculation. Rabbit corneas were inoculated with  Acanthamoeba  alone or  Acanthamoeba  plus PA and administered levofloxacin and betamethasone sodium phosphate (BSP) eye drops for 5 or 7 days. Infected rabbit eyes were evaluated for clinical score and  Acanthamoeba  by histological examination.  Acanthamoeba  alone and BSP treatment did not produce keratitis. Corneas inoculated with  Acanthamoeba  plus low-PA treated immediately with levofloxacin and BSP remained clear with few infiltrates. Corneas inoculated with  Acanthamoeba  plus low-PA treated with levofloxacin immediately and BSP 12 h later developed severe keratitis. Corneas inoculated with  Acanthamoeba  plus high-PA treated immediately with levofloxacin and BSP also developed severe keratitis. Acanthamoebae were detected by PAS staining in corneas inoculated with  Acanthamoeba  plus high-PA treated with levofloxacin and BSP. Topical corticosteroids have the potential to aggravate AK when cornea is infected by  Acanthamoeba  with a critical number of bacteria or when corticosteroids are given after infection has established by  Acanthamoeba  with small number of bacteria.

Corticosteroid eye drop instillation aggravates the development of Acanthamoeba keratitis in rabbit corneas inoculated with Acanthamoeba and bacteria