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Clinical Presentation and Microbial Analyses of Contact Lens Keratitis; an Epidemiologic Study

Seyed Ahmad Rasoulinejad, Mahmoud Sadeghi, Mohammad Montazeri, Hesam Hedayati Goudarzi, Mahmood Montazeri, Nadali Akbarian



Introduction: Microbial keratitis is an infective process of the cornea with a potentially and serious visual impairments. Contact lenses are a major cause of microbial keratitis in the developed countries especially among young people. Therefore, the purpose of the present study was to evaluate the frequency and microbiological characteristic of CLK in patients referred to the emergency department (ED) of teaching hospitals, Babol, Iran. Methods: This is a cross-sectional study of all patients with contact lens induced corneal ulcers admitted to the teaching hospitals of Babol, Iran, from 2011- 2013. An ophthalmologist examined patients with the slit-lamp and clinical features of them were noted (including pain, redness, foreign body sensation, chemosis, epiphora, blurred vision, discomfort, photophobia, discharge, ocular redness and swelling). All suspected infectious corneal ulcers were scraped for microbial culture and two slides were prepared. Data were analyzed using SPSS software, version 18.0. Results: A total of 14 patients (17 eyes) were recruited into the study (100% female). The patients’ age ranged from 16-37 years old (mean age 21.58±7.23 years). The most prevalent observed clinical signs were pain and redness. Three samples reported as sterile. The most common isolated causative organism was pseudomonas aeroginosa (78.6%), Staphylococcus aureus 14.3%, and enterobacter 7.1%, respectively. Treatment outcome was excellent in 23.5%, good in 47.1%, and poor in 29.4% of cases. Conclusion: Improper lens wear and care as well as the lack of awareness about the importance of aftercare visits have been identified as potential risk factors for the corneal ulcer among contact lens wearers. Training and increasing the awareness of adequate lens care and disinfection practices, consulting with an ophthalmologist, and frequent replacement of contact lens storage cases would greatly help reducing the risk of microbial keratitis.


Keratitis; contact lenses; ophthalmology; epidemiology; anti-bacterial agents


Fong CF, Tseng CH, Hu FR, Wang IJ, Chen WL, Hou YC. Clinical characteristics of microbial keratitis in a university hospital in Taiwan. Am J Ophthalmol. 2004;137(2):329-36.

Lam J, Tan G, Tan DT, Mehta JS. Demographics and behaviour of patients with contact lens-related infectious keratitis in singapore. Ann Acad Med Singapore. 2013;42(10):499-506.

Upadhyay MP, Srinivasan M, Whitcher JP. Microbial keratitis in the developing world: does prevention work? Int Ophthalmol Clin. 2007;47(3):17-25.

Keay L, Edwards K, Naduvilath T, et al. Microbial keratitis predisposing factors and morbidity. Ophthalmology. 2006;113(1):109-16.

Hoddenbach JG, Boekhoorn SS, Wubbels R, Vreugdenhil W, Van Rooij J, Geerards AJ. Clinical presentation and morbidity of contact lens-associated microbial keratitis: a retrospective study. Graefes Arch Clin Exp Ophthalmol. 2014;252(2):299-306.

Mah-Sadorra JH, Yavuz SG, Najjar DM, Laibson PR, Rapuano CJ, Cohen EJ. Trends in contact lens-related corneal ulcers. Cornea. 2005;24(1):51-8.

Pacella E, La Torre G, De Giusti M, et al. Results of case-control studies support the association between contact lens use and Acanthamoeba keratitis. Clin Ophthalmol. 2013;7:991-4.

Szczotka-Flynn LB, Pearlman E, Ghannoum M. Microbial contamination of contact lenses, lens care solutions, and their accessories: a literature review. Eye Contact Lens. 2010;36(2):116-29.

Evans DJ, Fleiszig SM. Microbial keratitis: could contact lens material affect disease pathogenesis? Eye Contact Lens. 2013;39(1):73-8.

Haghighi SHO, Begi HRM, Sorkhabi R, Tarzamani MK, Zonouz GK, Mikaeilpour A. Diagnostic Accuracy of Ultrasonography in Detection of Traumatic Lens Dislocation. Emergency. 2014;2(3):[In press].

Kiehlbauch JA, Hannett GE, Salfinger M, Archinal W, Monserrat C, Carlyn C. Use of the National Committee for Clinical Laboratory Standards guidelines for disk diffusion susceptibility testing in New York state laboratories. J Clin Microbiol. 2000;38(9):3341-8.

Mela EK, Giannelou IP, Koliopoulos JX, Gartaganis SP. Ulcerative keratitis in contact lens wearers. Eye Contact Lens. 2003;29(4):207-9.

Goh PP, Shamala R, Chandamalar S, Tai XY. Contact lens--related corneal ulcer: a two-year review. Med J Malaysia. 2010;65 Suppl A:120-3.

Galentine PG, Cohen EJ, Laibson PR, Adams CP, Michaud R, Arentsen JJ. Corneal ulcers associated with contact lens wear. Arch Ophthalmol. 1984;102(6):891-4.

Benhmidoune L, Bensemlali A, Bouazza M, et al. Contact lens related corneal ulcers: clinical, microbiological and therapeutic features. J Fr Ophtalmol. 2013;36(7):594-9.

Garg P. Diagnosis of microbial keratitis. Br J Ophthalmol. 2010;94(8):961-2.

Bharathi MJ, Ramakrishnan R, Meenakshi R, Kumar CS, Padmavathy S, Mittal S. Ulcerative keratitis associated with contact lens wear. Indian J Ophthalmol. 2007;55(1):64-7.

Stapleton F, Keay LJ, Sanfilippo PG, Katiyar S, Edwards KP, Naduvilath T. Relationship between climate, disease severity, and causative organism for contact lens-associated microbial keratitis in Australia. Am J Ophthalmol. 2007;144(5):690-8.

Wang AG, Wu CC, Liu JH. Bacterial corneal ulcer: a multivariate study. Ophthalmologica. 1998;212(2):126-32.

DOI: https://doi.org/10.22037/emergency.v2i4.6762


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