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Contact lensassociated microbial

keratitis (CLMK)

While contact lenses are safely used by

millions of people every day, they do carry a
risk of eye infection. The most common
infection related to contact lens use is
keratitis, an infection of the cornea (the
clear, round dome covering the eye's iris
and pupil).

Keratitis can have multiple causes, includingherpes,

bacteria,fungusand microbes (such as acanthamoeba
a very difficult infection to treat). Keratitis is the
most serious complication of contact lens wear.

In severe cases, it can lead to

corneal scarring that impairs
vision, and may lead to the need
for acornea transplant.

 Bacterial keratitis
Fungal keratitis
Herpes keratitis

Symptoms of contact lens-related infections may

include blurry vision, unusual redness of the eye,
pain in the eye, tearing or discharge from the
eye, increased light sensitivity or the sensation
of something in your eye.

It is important to remember that some

contact lens-related eye infections can
cause serious vision loss or even blindness,
so it is important to see your Eye M.D. as
soon as possible for treatment.

Factors that contribute to a contact lens-related

infection include:
Use of extended-wear lenses
Sleeping in your contact lenses
Reduced tear exchange under the lens
Environmental factors
Poor hygiene, including poor maintenance of contact
lens cases or reusing or topping off contact lens
solution

Bacteri
al

Bacterial

CLMK is mostly related to bacterial infection.

Bacterial keratitis is most commonly caused by
Pseudomonas spp.
Vary geographically according to climate and/or
temperature.
Temperate zones tend to have higher incidences of
gram-positive and less aggressive keratitis.

Cause
Contact lens use, especially extended-wear
lenses(overnight), contaminated contact lenses and poor
hygiene
Contaminated water (swimming or bathing)
Use of contaminated eye medicine or other solution
appliedto the eye
Use of topical steroids
Recent corneal disease
Reduced immunity due to diabetes, alcoholism or
poornutrition

Pseudomonas keratitis
- more virulent and hence vision-threatening
- contains enzymes that can digest the cornea
-intense inflammatory infiltrate

Gram-positive bacteria (S. epidermidis

and S. aureus) is the likely culprit in this
case of peripheral, focal,
nonsuppuritive keratitis.

Pseudomonas keratitis. There is a

large epithelial defect associated
with a ring-like stromal infiltrate,
which is soupy in appearance
owing to stromal necrosis. The
noninvolved areas of the cornea
have a characteristic ground
glass appearance. A small
hypopyon is present.

sudden onset and rapid

progression of
-

ocular pain
redness
tearing
photophobia
blurred vision
mucopurulent discharge

Treatment
Prevent possible blindness.
Refer to ophthalmologist corneal scrapping for
gram stain
Antibiotic drops
Topical steroid

Contact Lens-Related
Herpes simplex
Infection

Herpes keratitis
Herpes keratitis is a viral infection of the eye caused by the
herpes simplex virus (HSV).
Type I is the most common and primarily infects the face,
causing the familiar "cold sore" or "fever blister."
Type II is the sexually transmitted form of herpes, infecting
the genitals.

Signs and Symptoms

Pain
redness
blurred vision
tearing
discharge
sensitivity to light.

Transmission
Type I herpes is very contagious and is commonly
transmitted by skin contact with someone who has
the virus
Infection can be transferred to the eye by touching
an active lesion (a cold sore or blister) and then
your eye.

Risk factors
After the original infection, the virus lies in a dormant state, living in
nerve cells of the skin or eye. Reactivation can be triggered in a
number of ways, including:
Stress
Sun exposure
Fever
Trauma to the body (such as injury or surgery)
Menstruation
Certain medications
Once herpes simplex is present in the eye, it typically infects the
eyelids, conjunctiva and cornea. It may also infect the inside of the
eye

Herpes simplex virus

usually in dendritic ulcer
but may be other form

dendritic ulcer from HSV

dendritic ulcer from HZV

 the infection is superficial, involving only the

corneasouter layer (called the epithelium), it will
usually heal without scarring. However, it if involves the
deeper layers of cornea (which can happen after time),
the infection may lead to scarring of the cornea, loss of
vision and sometimes even blindness.
Left untreated, herpes keratitis can severely damage
your eye.

DIAGNOSIS
Diagnosis of HSV is usually made clinically,
however, definitive diagnosis can be made using
tissue culture or serum antigen detection
techniques.

Treatment
Most cases of herpes simplex virus (HSV) epithelial
keratitis resolve spontaneously within 3 weeks, the
rationale for treatment is to minimize stromal damage
and scarring. Gentle epithelial debridement may be
performed to remove infectious virus and viral antigens
that may induce stromal keratitis. Antiviral therapy,
topical or oral, is an effective treatment for epithelial
herpes infection
Mild infection is typically treated with topical and
sometimes oral antiviral medication
severe scarring and vision loss, a corneal transplant may
be required.

Medical treatment
anciclovir ophthalmic gel 0.15% - 5 times daily
Trifluridine 1% drops - 9 times daily
Vidarabine 3% ointment - 5 times daily
Oral acyclovir 400 mg - 5 times daily for 10 days [19];
oral acyclovir is the preferred treatment in patients
unable to tolerate topical medications and with good
renal function
A cycloplegic agent may be added to any of the above
regimens for comfort from ciliary spasm.

How to prevent the recurrence infection?

If you have an active cold sore or blister, avoid
touching your eyes.
Avoid steroid eye drops, as these cause the virus to
multiply.
Stop wearing contact lenses if you keep getting
infections.
See an ophthalmologist immediately if symptoms of
ocular herpes return.

What Is Fungal Keratitis?

Fungal keratitis is an infection of the cornea that
causes pain, reduced vision, light sensitivity and
tearing or discharge from your eye. Resulting
from infection from contact lens use or
frominjuryto the eye, fungal keratitis usually
develops very quickly, and if left untreated, can
cause blindness.

 Early diagnosis
diagnosis : difficulty in establishing the clinical diagnosis,
isolating the etiologic fungal organism in the laboratory
treatment : well response to topical antifungal agents

Delay diagnosis
diagnosis : easily detect from clinical presentation
treatment : poor corneal penetration of antifungal agents

Fungal Keratitis Causes

Fusaria

Most common fungus that

cause fungal keratitis
Found in soil, plant and water,
particularly in warmer climates
Immunocompromised host

Fungal Keratitis Causes

Other fungi
Aspergillus
Curvaria
Candida

Symptoms of fungal keratitis

Reduced vision
Pain in the eye (often sudden)
Increased light sensitivity
Tearing
Excessive tearing or discharge from your eye

Fungal keratitis

 To accurately diagnose fungal keratitis, Eye

M.D. may gently scrape the eye to take a
small sample of material and test it for
infection. Ophthalmologist will diagnose
whether your keratitis is fungal keratitis
orbacterial keratitis.

Treatment of fungal keratitis

Treatment of fungal keratitis usually includes
antifungal eye drops and oral medications. If
medical treatment is not effective in clearing the
infection, surgery may be required,
includingcorneal transplantation. In some cases,
even corneal surgery will not restore vision, and
permanent vision impairment or blindness may
occur. That is why it is so important to see your
Eye M.D. at the first sign of any ocular infection.

Acanthamoeba keratitis

How to wear and remove

CLs