Management Of Contact Lens Associated Keratitis: An 8-Month Longitudinal Study In A Tertiary Referral Centre

To identify the different risk factors associated with contact lens-associated keratitis (CLAK) in an urban setting, categorize and grade the types of CLAK, determine the outcomes of patients in the different subgroups with recommendations on modifications to current management protocols.

Tertiary referral centre at Moorfields Eye Hospital NHS Foundation Trust, London

A retrospective review of 161 eyes in 153 patients initially treated as CLAK between 1st July 2021 to 28th February 2022 (8 months) were included. The risk factors were analysed and the patients were categorized into 3 gradings based on the size of epithelial defect (ED) - Grade 1: <1.0mm, Grade 2: 1.0 – 2.0mm, Grade 3: >2.0mm. The outcomes of each individual subgroup were analysed and recommendations for current management protocols were made.

Extended-wear contact lenses (51.55%), a history of showering with contact lenses in-situ (31.68%) and duration of wear (29.81%) were the strongest risk factors associated with CLAK. Grade 1 CLAKs (<1.0mm) are predicted to have excellent outcomes (95.9% discharged at their first follow-up with 4 atypical presentations), Grade 2 CLAKs (1.0 – 2.0mm) are predicted to have good outcomes (94.1% discharged within 2 weeks with 1 atypical presentation) and Grade 3 CLAKs (>2.0mm) require prolonged average duration of treatment (39.63 days) in comparison with Grades 1 and 2 (13.94 days and 12.13 days respectively).

All typical Grade 1 and 2 CLAKs (≤2.0mm) are low risk and can be discharged with a standard regime of empirical treatment. All Grade 3 CLAKs (>2.0mm) should be reviewed as they require monitoring for resolution and further management. All CLAKs with atypical presentations regardless of size should be reviewed and empirical treatment can be started. Modern evidence-based treatment of microbial keratitis with fluoroquinolone is highly effective and our findings help busy emergency ophthalmic services cope with increasing demand by reducing unecessary follow-ups of low-risk CLAK and their safe discharge at the first visit with effective treatment and allow prioritisation of patients at higher risk of deterioration.