Diagnosis And Treatment Decisions Of A Corneal Ulcer In A Contact Lens Wearer: Multi Resistant Bacterial Infection With A Twist

To report the diagnostic challenges and medical management of a corneal ulcer with hypopyon in a patient with extended wear of contact lenses.

Clinical Emergency Eye Hospital Bucharest

This is a retrospective case report. The patient underwent full ophthalmological examination as well as ophthalmological paraclinical investigations. Bacterial cultures were carefully collected from the corneal ulcer and conjunctival fornices.

A 45 year old woman, swimmer and contact lens wearer, complained of rapid decline in visual acuity and ocular pain that worsened in the span of three weeks prior to the presentation. The ophthalmological examination was undertaken with the following findings: paracentral round stromal corneal ulcer with a central coma shaped infiltrate, subtle perilesional ring infiltrate, perilesional oedema, anterior chamber flare and hypopyon in the right eye. Empirical treatment was initiated. Bacterial cultures from the corneal swab came back positive after one week for a MRSA infection. Acanthamoeba coinfection was confirmed using in vivo confocal microscopy. Following antibiogram guided  optimized medical treatment, clinical resolution was achieved.

Corneal ulcers in contact lens wearers are usually caused by bacterial infections, staphylococcus aureus being one of the most frequent etiological agents. Acanthamoeba coinfection is higher in contact lens wearers that are swimming with their lenses on, than in the general population, therefore a high index of suspicion is needed for a correct diagnosis and optimal treatment, thus improving the long term outcome.