Pathogenesis and treatment of "sterile" midperipheral corneal infiltrates associated with soft contact lens use |
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Authors: | Baum J Dabezies O H |
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Institution: | Boston Eye Associates, Chestnut Hill, Massachusetts 02167-2115, USA. |
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Abstract: | PURPOSE: To demonstrate the sterile nature of presumed sterile midperipheral corneal infiltrates associated with soft contact lens (SCL) use and to show that withholding antibiotics or the occasional use of a topical corticosteroid alone may, with strict guidelines, have a role in the treatment of this entity. METHODS: Nine consecutive patients presenting with typical midperipheral corneal infiltrates after SCL wear were seen in the office (O.H.D.) during a 2-year period, 1996-1998. All patients were initially placed on topical fluorometholone as the only treatment. RESULTS: Eight of the nine patients experienced a rapid relief of symptoms and the infiltrates were noted to be smaller and less dense in 34 days. Therapy was discontinued after 7 days, by which time the lesions had cleared. The ninth patient developed a microbial keratitis from which Pseudomonas aeruginosa was cultured. With appropriate therapy, visual acuity returned to 20/25. Two different algorithms are offered for the treatment of a putative sterile infiltrate associated with SCL use. CONCLUSION: The use of a topical corticosteroid alone may have a role in the treatment of presumed sterile midperipheral corneal infiltrates associated with SCLs when strict guidelines are followed. Such therapy suggests that the infiltrates are not the result of infection. |
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