Contact Lens Related Bilateral Corneal Ulcers With Different Microorganisms

Published 2024 - 42nd Congress of the ESCRS

Reference: PO700 | Type: Poster | DOI: 10.82333/k5dm-wd95

Authors: Diana Shaghbatyan* ¹ , Roza Ohanyan ¹ , Zara Sargsyan ¹ , Lusine Kambulyan ¹ , Anna Hovakimyan ¹

¹Cornea-Uveitis Department ,S.V. Malayan eye center, Yerevan State Medical Univercity,Yerevan,Armenia

Purpose

To report a case of bilateral corneal ulcers with different microorganisms associated with contact lens wear, emphasizing the importance of thorough cultures and smears in diagnosis and management.

Setting

A 27-year-old male presented with symptoms of pain, redness, foreign body sensation, blurry vision, and tearing in both eyes after wearing contact lenses without a doctor's prescription.

Methods

The right eye exhibited dendritiform epitheliopathy, while the left eye showed a corneal ulcer upon slit-lamp examination. PCR and microbiological examination revealed no microorganisms in the right eye and Actinobacter baumanii in the left eye. Treatment was tailored based on the identified pathogen for the left eye, while only artificial tears were prescribed for the right eye.

Results

After three weeks of treatment, the left eye responded well to the prescribed regimen, with symptom resolution and corneal ulcer healing, albeit leaving mild paracentral haze. However, the right eye worsened, developing an immune ring and epithelial defect four weeks later. Presumed acanthamoeba keratitis was diagnosed, prompting initiation of treatment with chlorhexidine, PHMB, and Brolene eye drops. Subsequently, the patient developed associated immune scleritis, necessitating the addition of oral Ibuprofen to the treatment regimen. Scleritis resolved in three weeks, while keratitis responded over six months, leaving an anterior stromal scar.

Conclusions

This case emphasizes the rarity of bilateral contact lens-related keratitis with different pathogens. Although typically unilateral, bilateral involvement can occur, emphasizing the need for separate examination and tailored treatment for each eye. Additionally, this case highlights the prolonged treatment duration, up to six months, required for resolution in some cases. Thorough cultures and smears are essential for accurate diagnosis and optimal management in such cases.