Pseudomonas keratitis associated with continuous wear silicone-hydrogel soft contact lens: a case report

To report a case of Pseudomonas aeruginosa culture-positive microbial keratitis in a patient wearing continuous-wear silicone hydrogel soft contact lenses.

A 23-year-old white woman in good health had been wearing silicone hydrogel (lotrafilcon A) soft contact lenses continuously for 26 days when she was examined for a corneal ulcer in her left eye. She had given a history of water jet skiing and diving while wearing her contact lenses. Scrapings of the corneal ulcer were positive for P. aeruginosa, and the patient was treated with fortified topical cefazolin and gentamicin for 1 week and subsequently with topical ciprofloxacin for 2 weeks.

The microbial keratitis resolved with successful treatment. However, the patient had a residual visual deficit secondary to stromal scarring.

The recently introduced continuous-wear silicone hydrogel soft contact lenses, with their hyper oxygen permeability (Dk), have been shown to overcome hypoxia-associated complications and to have less P. aeruginosa binding to the corneal epithelium. Our case shows that sight-threatening microbial keratitis can still occur even with silicone hydrogel soft contact lenses. Contact lens practitioners should educate patients on the risk of sight-threatening microbial keratitis, the need for patient compliance, and prompt assessment of contact lens-related complaints.