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First Author: M.Besharati IRAN
Co Author(s): N. Oveisi M. Mahdavi
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To put into perspective the individual risk and the societal burden of contact lens microbial keratitis.
Shahid Sadoughi Hospital, Shahid Sadughi University of Medical Sciences, Yazd, Iran. A 19 years old girl presented with pain, epiphora and photophobia in right eye following wearing of cosmetic contact Plano lens. The lens has been bought a week before symptoms and was used three times and five hours for each time, patient removed out the lens at night. For the last time, three hours after wearing of lens, symptoms were initiated. Patient removed the lens out and referred to physician 24 hours later. She had previous history of any other predisposing diseases and based on history taking the health tips for using lens has been met.
During clinical examination, visual acuity of patient was count finger at four meters distance. In slit lamp examination, conjoint injection 2+, epithelial defect 4*4 millimeter and sub epithelial ring infiltration and 4+ cellules at anterior chamber was apparent. Eight hours after admission necrotic stromal infiltration, corneal melting, and corneal thinning edema was apparent that show progressive nature of disease .
After admission, ulcer scrab was done and specimen was sent for smear and culture. In smear gram negative bacilli was seen but culture was negative.Contact lens will increase risk of Pseudomonas aeruginosa keratitis. Risk factors in such patients are lack of hygiene, using the lens for long time, using lens during sleep and using lens after its expiration date. But the most prevalent cause is lack of hygiene . About 36%-64% of cases with microbial keratitis have positive microbial culture. Pseudomonas aeruginosa is the leading cause of contact lens-induced keratitis and corneal ulcers . P. aeruginosa is a gram-negative bacterium, which typically produces a sweet odor that makes it possible to diagnose the bacterium from other bacteria in culture. Ordinary, pseudomonas aeruginosa is considered as an opportunistic pathogen, it has tendency to cause infections in immune-compromised patients. Immune-compromised environments in the eye, such as cornea, aqueous humor, and vitreous humor may also be a host. In the eye, extracellular enzymes cause a rapidly destructive lesion, which may lead to keratitis, corneal ulcer, and endophthalmitis .
Pseudomonas keratitis has a rapidly progressive nature and need for repeated clinical examination and appropriated emergency management with antibiotics. Prompt diagnosis of keratitis and corneal ulcers and treatment with appropriate antibiotics prevent blindness and devastating visual disability . Patients that wear cosmetic lenses are at a higher risk because of lower patient education and the absence of follow-up visits.. Resistance to antibiotics such as chloramphenicol, cefazolin, and trimethoprim is very common. Based on suggestion of studies, ceftazidime or ciprofloxacin in combination with amikacin is the most effective regimen for the initial treatment of keratitis and corneal ulcers .