Infectious keratitis and corneal ulcers associated with contact lens wear

Abstract

Background: Сontact lenses (CL) are widely used to correct refractive errors. Microbial keratitis is one of the most common complications in contact lens wearers. The severity of CL-associated microbial keratitis ranges from mild to severe and poses a risk of vision loss. Purpose: To analyze clinical cases of infectious keratitis and corneal ulcers associated with contact lens wear in patients hospitalized in the Corneal Pathology Department from January 1, 2024, to December 30, 2025. Methods: All cases of patients hospitalized in the Corneal Pathology Department from January 1, 2024, to December 30, 2025, with infectious keratitis (IK) and corneal ulcers (CU) associated with contact lens (CL) wear were retrospectively analyzed. The following data were analyzed: duration of CL lens wear and their type, duration of therapy before hospitalization, size of the corneal infiltrate or ulcer, presence of hypopyon, isolated microorganism, type of treatment (conservative, surgical), and visual acuity before and after treatment. Patients with therapeutic contact lenses and autoimmune diseases were excluded. Results: A total of 32 cases of 30 patients hospitalized with IK (n=7) and CU ( n=25) associated with CL wear during the specified period were analyzed. Mean age was 42 ± 13.6 (SD) years, with womens predominance 21(70.0%). The mean duration of CL wear was 9.2 ± 8.7 (SD) years. All patients used long-term wear silicone hydrogel soft CL. Infectious keratitis was detected in 7 cases (21.9%), ulcers – in 25 (78.1%). Positive culture were in 23 cases (71.9%), of which gram-negative bacteria – in 12 cases (52.2%), including Pseudomonas aeruginosa – in 8 (66.7%), fungi – in 3 cases (13.0%). The size of the inflammatory infiltrate was 4.3 ± 2.7 (SD) mm,, hypopyon presence - in 14 cases (43.8%). 20 patients (62.5%) were treated conservatively, keratoplasty was required in 12 cases (37.5%). Visual acuity upon hospitalization was below 0.05 in 19 patients (63.3%), after treatment it improved in 29 patients (90.6%). Conclusion: Infectious keratitis and corneal ulcers remain a serious complication in contact lens wearers, requiring keratoplasty in a significant number of cases. Gram-negative flora and fungi cause the most severe keratitis and ulcers in CL wearers and require monitoring by an ophthalmologist and forced instillations regime of antimicrobial drugs initially.