Contact lens–related corneal ulcers in compliant patients (original) (raw)
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Acta Ophthalmologica Scandinavica, 2006
Purpose: To evaluate the clinical and epidemiological aspects of contact lensrelated infectious corneal ulcers requiring hospitalization. Methods: A retrospective analysis was performed on the files of patients hospitalized for contact lens-induced corneal ulcer in the eight Belgian university hospitals over a 7-year period (January 1997 to December 2003. Diagnoses for all hospitalized patients are obligatorily registered using the ICD-9 code. Results: A total of 107 patients with contact lens-related corneal ulcers were documented: the number increased from five in 1997 to 22 in 2003. A total of 99 subjects used soft contact lenses, of whom nine used disposables, 73 planned replacement and 17 conventional lenses. Only six patients used extended wear lenses. Three patients used daily disposable lenses. The most frequently cultured organisms were Pseudomonas and other Gram-negative germs (70%) and Acanthamoeba (16%). The majority (77%) of the corneal ulcerations were centrally located and resulted in an average visual loss of four lines. Conclusion: During the study period, the number of patients hospitalized rose, which is only partially explained by the increasing prevalence of lens wearers: 3.5% and 6.5% of the Belgian population used lenses in 1995 and 2003, respectively. These factual data highlight the need for improvements in patient education.
Corneal Ulcer and Adverse Reaction Rates in Premarket Contact Lens Studies
American Journal of Ophthalmology, 1991
We analyzed clinical data on 22,739 contact lens wearers who were studied and whose lenses were approved under 48 manufacturersponsored studies for the Food and Drug Administration between 1980 and 1988. The incidence of corneal ulcers was low in the cosmetic (nontherapeutic) daily-wear soft and rigid gas-permeable lens wearers (1/1,923 and 1/1,471 patient-years, respectively). Corneal ulcers and severe adverse reactions occurred two to four times more frequently in extend ed-wear cosmetic soft and rigid gas-perme able lens wearers than in cosmetic daily-wear lens wearers. Aphakic extended-wear soft lens users were nine times more likely to develop a corneal ulcer when compared to the soft daily-wear cosmetic group. Corneal abra sions and keratitis accounted for 81 of 159 severe adverse reactions, whereas corneal ul cers accounted for 28 of 159 adverse reactions. The data indicate that overnight extended wear of contact lenses is associated with a greater risk of serious, sight-threatening com plications than daily wear.
Good Outcome of Corneal Ulcer With Hypopion After Long Use of Contact Lens
Vision Science and Eye Health Journal
Introduction: Microbial keratitis is a corneal infection caused by microorganisms and is characterized by a profound corneal epithelial defect that infects the cornea and causes severe and progressive visual loss. In recent years, the incidence of microbial keratitis has increased. One of the critical risk factors for increasing this incidence is using contact lenses. As the number of contact lens users increases, the number of corneal ulcers associated with contact lenses also increases. Case Presentation: A 25-year-old man was admitted to the emergency department with a complaint of gradually blurry vision in his left eye four days after using contact lenses for overnight uses since the previous few days and did not routinely clean contact lenses or replace contact lens cleaning fluid. The visual acuity of the patient's left eye was hand movement with conjunctival and pericorneal injection in the conjunctiva and 6 x 7 mm stromal level infiltrate, blurred margin, and whitish co...
Ulcerative Keratitis in Contact Lens Wearers
Eye & Contact Lens: Science & Clinical Practice, 2003
To determine the clinical microbiological characteristics of corneal ulcers in contact lens wearers. Methods: A retrospective study of 23 patients admitted to our department with contact lens-related corneal ulcers during a 43-month period. Detailed demographic data, the type of contact lens, duration of lens wear, and wearing schedule were derived from a self-administered questionnaire. The severity of the ulcer; cultures of corneal scrapings, storage solutions, and contact lenses; treatment; and final outcome were evaluated. Results: Of the 86 cases of ulcerative keratitis admitted during the study period, 23 (26.74%) were attributed to contact lens use. Most patients were young women from urban areas. All of them were using soft contact lenses for 3 days to 20 years. Five patients used daily-wear lenses as extended-wear lenses. Most ulcers (47.82%) were mild; 30.43% were moderate; and 21.47% were severe. Corneal scrapings for cultures were obtained in 15 of the cases and were positive in 10 (43.47%) of them, whereas in 33.33% of the culture-positive storage solutions and in 66.67% of the culture-positive contact lenses, corneal scrapings were negative. Pseudomonas aeruginosa was the most frequent isolated pathogen (60%). The final visual acuity was 20/40 or better in 60.87% of the cases. Conclusions: Contact lens use is an important risk factor for the development of ulcerative keratitis, with P. aeruginosa remaining the predominant pathogen. It seems important to culture contact lenses and contact lens storage solutions, in addition to the corneal scrapings, and the role of initial therapy for the corneal ulcers remains important.
Trends in Contact Lens???Related Corneal Ulcers
Cornea, 2005
Purpose. To identify changes in number of contact lens-related corneal ulcers per year and the type of contact lenses involved. Methods. Charts of 299 patients with corneal ulcers seen at the Cornea Service of Wills Eye Hospital from January 1, 1996, to June 30, 1999, were retrospectively reviewed. A corneal ulcer was defined as an infiltrate that was treated at least hourly with topical fortified antibiotics or fluoroquinolones. Results. Of these 299 cases, 37 (12.4%) were related to contact lens use. Contact lensrelated ulcers accounted for 10.7% of all corneal ulcers in 1996, 15.3% in 1997, 8.6% in 1998, and 18.2% in the first 6 months of 1999. The contact lenses most commonly associated with ulcers were conventional soft daily-wear contact lenses (33%). There were similar numbers of ulcers associated with extended wear (n ס 16) and daily wear (n ס 17) of soft contact lenses. In addition, the number of cases associated with conventional (n ס 17) and disposable/frequent replacement (n ס 16) lenses were similar. Corneal cultures were performed in 15 (40.5%) cases and were positive in 8. There has been a significant decrease in the number of contact lens-related ulcers treated at our institution compared with previous years (1988-1999, p < 0.01). Conclusions. The number of contact lens-related corneal ulcers in the past 4 years was significantly fewer than previous years at our institution. A similar number of ulcers were associated with conventional and disposable/frequent replacement lenses despite the commercial preponderance of the latter type of lenses.
Contact Lens Induced Corneal Ulcer Management in a Tertiary Eye Unit in Oman - A descriptive study
Sultan Qaboos University medical journal, 2008
The corneal disease is a priority problem in Oman. We present patients with contact lens (CL) induced severe keratitis, admitted in the corneal unit of Al Nahdha Hospital in Oman. The study was conducted in 2005-2006. Ophthalmologists examined the eyes using slit lamp bio-microscope. Visual acuity was noted using Snellen's distance vision chart. Specimens of corneal scraping and CLs were sent for culture and sensitivity tests. Patients with severe keratitis were admitted and treated with medicines. Corneal and visual statuses were noted at the time of discharge from hospital and after six weeks. Numbers, percentages and their 95% confidence intervals were calculated. Pre- and post-treatment vision were compared using a scattergram. The 52 eyes of 15 males and 37 female patients with corneal ulcers were examined. Thirty-two patients were between 20 to 30 years of age. Only 13 (25%) patients had visited an ophthalmologist within 24 hours of developing severe keratitis. Seventeen (...
Clinical Presentation and Microbial Analyses of Contact Lens Keratitis; an Epidemiologic Study
Introduction: Microbial keratitis is an infective process of the cornea with a potentially and serious visual impairments. Contact lenses are a major cause of microbial keratitis in the developed countries especially among young people. Therefore, the purpose of the present study was to evaluate the frequency and microbiological characteristic of CLK in patients referred to the emergency department (ED) of teaching hospitals, Babol, Iran. Methods: This is a cross-sectional study of all patients with contact lens induced corneal ulcers admitted to the teaching hospitals of Babol, Iran, from 2011- 2013. An ophthalmologist examined patients with the slit-lamp and clinical features of them were noted (including pain, redness, foreign body sensation, chemosis, epiphora, blurred vision, discomfort, photophobia, discharge, ocular redness and swelling). All suspected infectious corneal ulcers were scraped for microbial culture and two slides were prepared. Data were analyzed using SPSS software, version 18.0. Results: A total of 14 patients (17 eyes) were recruited into the study (100% female). The patients’ age ranged from 16-37 years old (mean age 21.58±7.23 years). The most prevalent observed clinical signs were pain and redness. Three samples reported as sterile. The most common isolated causative organism was pseudomonas aeroginosa (78.6%), Staphylococcus aureus 14.3%, and enterobacter 7.1%, respectively. Treatment outcome was excellent in 23.5%, good in 47.1%, and poor in 29.4% of cases. Conclusion: Improper lens wear and care as well as the lack of awareness about the importance of aftercare visits have been identified as potential risk factors for the corneal ulcer among contact lens wearers. Training and increasing the awareness of adequate lens care and disinfection practices, consulting with an ophthalmologist, and frequent replacement of contact lens storage cases would greatly help reducing the risk of microbial keratitis.
Infected vs sterile corneal infiltrates in contact lens wearers
American Journal of Ophthalmology, 1988
We examined 50 patients to determine whether differences exist between the initial clinical signs and symptoms associated with infected vs sterile corneal infiltrates. A de tailed history regarding contact lens use and ocular symptoms was taken, after which a careful slit-lamp examination was performed. The ocular findings were correlated with the results of corneal cultures. Increased pain (P < .001), discharge (P < .0001), epithelial staining (P < .0001), and anterior chamber reaction (P < .0001) were associated with infected ul cers. Sterile infiltrates were usually smaller; multiple or arcuate; and without significant pain, epithelial staining, or anterior chamber reaction. CORNEAL ULCERS are the most serious compli cation associated with contact lenses. 114 Corne al infiltrates in contact lens wearers may be infected or sterile. Decisions regarding the need to perform corneal scrapings for smears and cultures and to initiate broad-spectrum fortified antimicrobial therapy will depend on the clinical impression of the nature of the infiltrate. We designed this study to determine which clinical symptoms and signs were impor tant in predicting whether a corneal infiltrate was infectious or sterile. This information is helpful in determining the optimal initial thera py of contact lens-associated corneal ulcers. Subjects and Methods We performed a prospective study on pa tients with untreated corneal infiltrates and a