What happens when one leaves soft contact lenses in for three weeks A case of bilateral, severe pseudomonas keratitis from contact lenses purchased over the internet.pdfVIP

Contact Lens and Anterior Eye 39 (2016) 318–320 Contents lists available at ScienceDirect Contact Lens and Anterior Eye journal homepage: /locate/clae Correspondence What happens when one leaves soft contact lenses in for three weeks? A case of bilateral, severe pseudomonas keratitis from contact lenses purchased over the internet Keywords: Keratitis Corneal ulcer Soft contact lenses Pseudomonas aeruginosa Dear Sir, A 50-year-old male contact lens wearer was referred to the outof-hours emergency eye clinic for a three-day history of worsening bilateral eye redness, pain and rapid loss of visual acuity over the course of the previous 24 h. He obtained his daily disposable soft (silicone hydrogel) lenses from the Internet, he was not registered with a GP and did not attend optometrists for review. His visual acuities (VA) were perception of light (PL) in the right eye (RE) and hand movements (HM) in the left eye (LE). He presented with bilateral, extensive, corneal ulceration with a 5 mm hypopyon in the right eye and no view of the posterior segment in either eye. The patient reported to have left his contact lenses (CL) in situ for over three weeks, having previously worn CL for two weeks at a time with “no problem” and wanting to try to extend the interval in order to save money. He had no signi?cant past ophthalmic or systemic medical history. On examination, he presented with severe bilateral conjunctival hypaeremia, an extensive right epithelial defect (11 mm in diameter) with right central stromal in?ltrate (8 mm diameter) (Fig. 1A and B) and a large left central epithelial defect (5.7 mm diameter) with left stromal in?ltrate (4.2 mm diameter) (Fig. 1C and D). There was a 5 mm hypopyon in the right eye (Fig. 1A) and the CL were not in situ. The corneal scrapes and cultures showed growth of Pseudomonas aeruginosa bilaterally and the patient responded well to hourly guttae cipro?oxacin combined with oral levo?oxacin, followed by topical guttae dexamethasone 0.1% d