Clinical Case Database / Category: Patient Management
Contact lens related keratitis
Publication details
Mr Simon Hardman-Lea, Dr Panayiotis Vouzounis
Foundation Years Journal, volume 9, issue 6, p.19 (123Doc Education, London, June 2015)
Abstract
Contact lens wearers frequently present acutely with a painful red eye. This must be assumed to be infectious keratitis when first seen. A number of different pathogens can be involved. Factors that predispose to corneal infection include contact lens wear, trauma, surgery or chronic ocular surface disease.
There is an interesting paper published in 2008 on the incidence of contact les related microbial keratitis in Australia. It was concluded that new lens types did not reduce the incidence of disease and that overnight use of any contact lens was associated with a higher risk than daily use. In particular, the risk of microbial keratitis from wearing a contact lens was calculated to be about 1 in 2,500). New lens types did not reduce the incidence of disease. Overnight use of any contact lens was associated with a higher risk than daily use. In summary, the risk of microbial keratitis from wearing a contact lens is about 1 in 2,500. This does not mean that you will lose sight from it. To be more specific, 10% out of that group will lose two lines of vision and therefore, there is a 1 in 25,000 risk of visual loss.
Hence, a specific practical approach to the management of these patients is required to avoid permanent, sight threatening complications. This paper presents one case history and discusses appropriate management for a non-specialist by question and answer. It then briefly illustrates a further two cases with different aetiologies.
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Authors
Mr Simon Hardman-Lea
Consultant Ophthalmic Surgeon
Ipswich Hospital NHS Trust
Heath Road, Ipswich, Suffolk, IP4 5PD
simon.hardman-lea@ipswichhospital.nhs.uk
Dr Panayiotis Vouzounis (Corresponding author)
Clinical Fellow, Ophthalmology
Ipswich Hospital NHS Trust
Heath Road, Ipswich, Suffolk, IP4 5PD
panosvouzounis@doctors.org.uk
References
1. Tuft S. The Cornea. In: Spalton David J, Hitchings Roger A, Hunter Paul eds. Atlas of Clinical Ophthalmology, 3rd edn. Elsevier 2005, 147-185.
2. Stapleton F, Keay L, Edwards K, Naduvilath T, Dart JK, Brian G, et al. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008 Oct;115(10):1655-62. PubMed PMID: 18538404.
3. Dart JK, Radford CF, Minassian D, Verma S, Stapleton F. Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology. 2008 Oct;115(10):1647-54, 54 e1-3. PubMed PMID: 18597850.
4. Bourkiza R, Kaye S, Bunce C, Shankar J, Neal T, Tuft S. Initial treatment of Pseudomonas aeruginosa contact lens-associated keratitis with topical chloramphenicol, and effect on outcome. Br J Ophthalmol. 2013 Apr;97(4):429-32. PubMed PMID: 23343655.
5. Dart JK, Saw VP, Kilvington S. Acanthamoeba keratitis: diagnosis and treatment update 2009. Am J Ophthalmol. 2009 Oct;148(4):487-99 e2. PubMed PMID: 19660733.
6. Srinivasan M, Mascarenhas J, Prashanth CN. Distinguishing infective versus noninfective keratitis. Indian J Ophthalmol. 2008 May-Jun;56(3):203-7. PubMed PMID: 18417820. Pubmed Central PMCID: 2636110.
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The Foundation Years Clinical Cases Database is a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.
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