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Pathogenesis and treatment of "sterile" midperipheral corneal infiltrates associated with soft contact lens use
1Boston Eye Associates, Chestnut Hill, Massachusetts 02167-2115, USA.
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 3-4 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.
Insights
Topical corticosteroids may effectively treat sterile corneal infiltrates in soft contact lens (SCL) wearers. This approach suggests these infiltrates are not infectious, offering a treatment alternative.
Area of Science:
- Ophthalmology
- Corneal Diseases
- Contact Lens Complications
Background:
- Midperipheral corneal infiltrates are a common complication associated with soft contact lens (SCL) wear.
- The sterile nature of these infiltrates is often presumed but requires demonstration.
- Current treatment paradigms may involve antibiotics, but alternatives are being explored.
Purpose of the Study:
- To confirm the sterile nature of midperipheral corneal infiltrates in SCL users.
- To evaluate the efficacy of withholding antibiotics and using topical corticosteroids alone for treatment.
- To establish treatment guidelines for presumed sterile infiltrates.
Main Methods:
- A prospective study of nine patients with SCL-associated midperipheral corneal infiltrates.
- Initial treatment involved topical fluorometholone as the sole therapeutic agent.
- Patient response and infiltrate characteristics were monitored over a 7-day period.
Main Results:
- Eight out of nine patients showed rapid symptom relief and reduced infiltrate density within 3-4 days.
- Lesions cleared completely in seven days for the majority of patients.
- One patient developed microbial keratitis (Pseudomonas aeruginosa) but recovered with appropriate treatment.
Conclusions:
- Topical corticosteroid monotherapy can be effective for presumed sterile midperipheral corneal infiltrates in SCL wearers under strict guidelines.
- This treatment approach supports the hypothesis that these infiltrates are non-infectious.
- The study offers treatment algorithms for managing these specific corneal infiltrates.
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