A Guide to Clinical Contact Lens Management

Signs, Symptoms, Diagnosis and Management

Academy for Eyecare Excellence™
IN COOPERATION WITH
Centre for Contact Lens Research
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Infiltrates keratitis

Video: Infiltrates (Central and Fine)

Infiltrates (Central and Fine)

Video: Infiltrates (Diffuse and Peripheral)

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Infiltrates (Diffuse and Peripheral)

Infiltrates – Infiltrative Keratitis

Marginal keratitis, asymptomatic infiltrative keratitis, marginal infiltrate, sterile infiltration

Symptoms

  • Minor infiltrates may be asymptomatic
  • Discomfort, foreign body sensation
  • Redness
  • Mild photophobia
  • Symptoms reduce on lens removal

Signs

  • Single or multiple circular infiltrates in epithelium or anterior stroma
  • May be unilateral or bilateral
  • Localized bulbar and/or limbal hyperemia adjacent to infiltrates
  • Overlying epithelium generally does not stain

Etiology

  • Inflammatory reaction resulting in accumulation of white blood cells in cornea
  • Response to hypoxia, chemical toxicity, cellular debris, allergens, denatured protein, exotoxins and/or endotoxins from bacteria

Prevalence

  • Infrequent

Differential Diagnosis

Management

  • Remove cause of inflammatory response
  • In severe cases, discontinue lens wear until infiltrate totally resolves
  • Prophylactic antibiotic may be prescribed
  • Mild steroid may be prescribed
  • Treat blepharitis if present
  • Review within 1 week. Resolution may require > 2 weeks
  • May change to DW, change to a higher Dk lens, increase lens replacement frequency (DD), change care system
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