Trends in Contact Lens-Associated Corneal Ulcers

Abstract

Purpose: : To review the frequency of contact lens-associated corneal ulcers, microbiologic characteristics and predisposing factors for ulcers among contact lens wearers in 2006 and 2007 and compare them to previous years.

Methods: : Charts of 301 patients with corneal ulcers examined at the Cornea Service of Wills Eye Institute from January 1, 2006 to December 31, 2007 were retrospectively reviewed. The cases were identified using a computer-generated list using diagnostic codes for presumed bacterial ulcers. All patients with contact lens-associated corneal ulcers were identified. A corneal ulcer was defined as an infiltrate that was treated at least hourly with topical fortified antibiotics or fluoroquinolones. The data is presented in two subgroups, one subgroup (n= 162) was seen in the office-based tertiary referral private clinic and the other subgroup (n= 139) was seen in the resident-in-training (RIT) cornea clinic.

Results: : Contact lens-associated ulcers accounted for 73 of 162 (45%) ulcers seen in the private clinic, and 86 of 139 (62%) cases seen in the RIT cornea clinic. Eighty three of 164 (50.6%) corneal ulcers were associated with contact lenses at our institution in 2006. This number increased to 76 of 137 (55.5%) in 2007. Daily-wear soft frequent replacement lenses were the most common lens type associated with corneal ulcers (n = 89/159, 56%). Corneal cultures were performed in 134 of 159 (84%) cases and were positive in 74 cases (55%). Pseudomonas continues to be the predominant organism isolated (44 in 74 positive cases; 59%). Culture-proven Pseudomonas infections occurred in 9 of 19 (47%) silicone hydrogel lens wearers in 2006 and 3 of 13 (23%) in 2007. The frequency of contact lens-associated corneal ulcers in the current study was greater than that from years 1999-2002 (n= 113/276, 30%). Additional results from the years 2003 to 2005 will be presented.

Conclusions: : There was an increase in the number of contact lens-associated corneal ulcers in the reporting period compared with reported previous years. Contact lens wear remains an important risk factor for developing corneal ulcers despite use of frequent-replacement daily-wear contact lenses.

Keywords: contact lens • keratitis • cornea: clinical science