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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Microbial keratitis slit lamp
Microbial keratitis

Video: Microbial Keratitis - Central with Hypopyon

Microbial Keratitis - Central with Hypopyon

Microbial Keratitis

Corneal ulcer, infectious keratitis, ulcerative keratitis, corneal infection

Symptoms

  • Acute severe pain
  • Extreme redness – usually all quadrants
  • Epiphora and photophobia
  • No improvement with lens removal

Signs

  • Localized corneal excavation, penetrating into the stroma, with underlying infiltrate and surrounded by edema
  • Generally central or paracentral, large (>1mm), irregular appearance
  • Typically unilateral
  • Severe hyperemia and possibly lid edema.
  • Mucopurulent or watery discharge, aqueous flare often present
  • Also see Acanthamoeba Infection

Etiology

  • Infection with epithelial disruption
  • Most virulent pathogens are Pseudomonas aeruginosa and Acanthamoeba

Prevalence

  • Rare
  • Higher prevalence in EW of soft lenses

Differential Diagnosis

Management

  • Cease lens wear immediately
  • Consider culturing before initiating antibiotic therapy, particularly for large central ulcers
  • Instigate topical antibiotic treatment immediately. Follow up daily until resolved
  • Replace all lenses and lens care products including lens case before recommencing lens wear
  • Further lens wear should be restricted and be undertaken cautiously
  • Further EW inadvisable and may recommend DW
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