The occurrence of Acanthamoeba keratitis is increasing in the United States because of an expanding population at risk of infection and sporadic outbreaks of infection. Such outbreaks are the result of lapses in contact lens wear and care and of alterations in water quality and water treatment procedures. Although improved techniques in diagnosis are available, better identification of infection alone does not explain an increase in the observed occurrence of the disease. Likewise, there does not appear to be an increase in the virulence or infectivity of the amoebae. Strategies for prevention, including patient education, improved decontaminating agents, maintenance of water treatment standards, and possible immunization of subjects at risk, are needed.