CONTACT LENS INDUCED KERATITIS

To report the clinical presentation and management of a case of a 40 year old women with high myopia ; who wears hard contact lens for 10 years ; presenting a infectious keratitis in the right eye . Infectious keratitis is the most serious complication of contact lens use. Virtually all contact lens wearers are at risk. Initial therapy consists of frequent broad-spectrum fortified antibiotic drops after appropriate laboratory workup. Pseudomonas and Acanthamoeba species are the most important causes of contact lens-associated ulcers. Acanthamoeba keratitis isolated or associated with other germ produces significant ocular morbidity, and treatment is not always effective. 

Department of Ophthalmology, Ibn Sina Hospital, Rabat, Morocco.

A 40-year-old women ; who wears hard contact lens for 10 years for high myopia -15 D presented with complaints of a 3 days  history of non-traumatic unilateral red eye, with pain; redness and photophobia. The corrected vision was hand motion in the right eye .Slit lamp examination revealed a 4mm*4,5 mm central ring-shaped stromal infiltrate, along with corneal haze and an overlying epithelial defect, which showed uptake of fluorescein; and the presence of  corneal thinning in the central region ; without any inflammation in the anterior chamber ; or hypopion . Findings of anterior segment optical coherence tomography (AS-OCT) were epithelial irregularity, hyperreflectivity on anterior stromal layer, lobulated stromal surface; and thinning in the central cornea of 400 µm. The diagnosis of acanthamoebic keratitis should be suspected in any contact lens wearer ; or associated to other microorganisms.

Fortified antibiotics drops (vancomycin and  Ceftazidime) were administered every  hour in the first 24 H then every 4 hours; and ketoconazole was initiated; with cycloplegics; and Diamox for the thinning . The culture of corneal scraping was positif for Escherichia coli. The evolution was satisfactory, with remission of the corneal haze ; re epithelialization and stability of the thinning .The patient is a candidate for a keratoplasty after stabilisation.

Even under the best of lens care conditions, infectious keratitis may still occur. It is therefore imperative that patients be informed to remove their lenses and seek medical evaluation if any discomfort develops.