Corneal ring infiltration in contact lens wearers.

Area of Science:

• Ophthalmology
• Corneal Diseases
• Microbiology

Background:

• Soft silicone hydrogel contact lenses are widely used but can be associated with microbial keratitis.
• Poor contact lens hygiene is a significant risk factor for developing corneal complications.
• Sterile corneal infiltrates, while less common, can mimic infectious keratitis and require careful diagnosis.

Observation:

• A 29-year-old female presented with pain, redness, and discharge, wearing soft silicone hydrogel contact lenses.
• Examination revealed a dense, ring-shaped stromal infiltrate with epithelial edema and defect.
• Cornea-specific in vivo laser confocal microscopy identified Langerhans cells, ruling out Acanthamoeba or fungal infections.

Findings:

• The case presented as an atypical sterile corneal ring infiltrate.
• Smear, culture, and confocal microscopy confirmed a sterile inflammatory reaction, not an infection.
• Treatment with lid scraping and anti-inflammatory drops resulted in complete visual recovery.

Implications:

• This case underscores the importance of differentiating sterile infiltrates from infectious keratitis in contact lens wearers.
• Proper contact lens care and hygiene are crucial to prevent sight-threatening corneal complications.
• Confocal microscopy is a valuable tool in diagnosing sterile inflammatory conditions of the cornea.