Microbial keratitis and corneal ulceration associated with therapeutic soft contact lenses

We reviewed the records of 22 patients whose corneal ulcers were associated with therapeutic soft contact lens wear. The patients required hospitalization on the Cornea Service at Wills Eye Hospital between January 1, 1978 and September 1, 1988. A majority of the ulcers were associated with pseudophakic or aphakic bullous keratopathy (9 of 22 cases; 41%); neurotrophic/exposure keratitis was the second most common diagnosis (7 of 22; 32%). Most patients used topical antibiotics (15 of 22; 68%) and/or corticosteroids (13 of 22; 59%). Cultures were positive in 15 of 22 cases (68%). Gram-positive organisms were isolated in 60% the culture-positive cases (9 of 15). Streptococcus was the most common organism isolated (6 of 15 culture positive-cases; 40%). Gram-negative organisms were found in four of 15 culture-positive ulcers (27%). There was only one Pseudomonas infection in the series. Uncommon organisms--including Candida, atypical mycobacteria, Achromobacter, Acinetobacter and Micrococcus--were isolated in five cases. Therapeutic soft contact lens wearers are at risk for developing corneal ulcers; most often these are caused by gram-positive bacteria, especially streptococci, and uncommon organisms.