Contact lens-related versus non-contact lens-related Pseudomonas aeruginosa keratitis: The Midlands Infectious...

Pseudomonas aeruginosa (PA) is a major cause of infectious keratitis worldwide. Contact lens (CL) wear is a key risk factor, though other predisposing factors exist. This study compared clinical features, risk factors, and outcomes of CL-related versus non-CL-related PA keratitis in the United Kingdom (UK).

A retrospective cohort study of culture-confirmed PA keratitis cases that presented to the Birmingham and Midland Eye Centre (Birmingham, UK) and Queen's Medical Centre (Nottingham, UK) between August 2016 and January 2020. Demographics, clinical characteristics, risk factors, and outcomes were analysed and compared between CL-related and non-CL-related groups.

Sixty-six patients (66 eyes) were included; mean age was 54.0 ± 20.9 years and 59.1% were female. CL wear accounted for 35 (53.1%) cases. At presentation, mean CDVA was 1.26 ± 0.96 logMAR (~6/120 Snellen). Hospitalisation occurred in 71.2% cases, with 19.7% cases requiring surgery. Most isolated PA (64, 97.0%) were antibiotic-susceptible. Compared to non-CL-related keratitis, CL-related keratitis was more commonly associated with younger age, better initial vision, smaller and non-central ulcers, and absence of hypopyon (all p < 0.05). CL-related cases had a significantly lower risk of poor visual outcome (>0.6 logMAR; adjusted odd ratio = 0.13, 95% CI 0.01-0.84, p = 0.046; multivariable logistic regression) and faster rate of corneal healing (median: 17 days vs. 32 days; p = 0.029; unadjusted Kaplan-Meier analysis).

PA keratitis remains a significant cause of ocular morbidity in the United Kingdom. CL-related disease shows distinct clinical features and better outcomes likely due to lower presenting disease severity and timely management of the disease.