Disposable soft contact lens ulcers: a study of 43 cases seen at Manchester Royal Eye Hospital

We report an outbreak of 43 episodes of presumed microbial keratitis in 42 disposable soft contact lens wearers seen in the Accident Room of Manchester Royal Eye Hospital during a period of 20 months, and compare this with the general incidence of contact lens-related corneal infection found in a retrospective survey of 6 months' Accident Room attendances during the same period. Thirty-seven patients had worn Acuvue lenses, three had worn Nuvue, and there was no record in two cases. Corneal scrapes were taken for microbiological examination in 27 patients, and 6 of these were culture positive. Conjunctival swabs were taken from eight eyes and one was culture positive. The contact lenses of 11 patients were sent for culture and all grew pathogenic organisms. Pseudomonas spp. were the most common organisms grown, having been found in three of six corneal scrapes and six of 11 contact lens cultures. All affected eyes responded promptly to cessation of contact lens wear and topical antibiotic therapy, with none sustaining severe or permanent visual loss. Reasons for the associated high risk of microbial keratitis are discussed. Thirty-three of the 42 patients responded to a questionnaire regarding lens wear and care and their responses are reported. In consequence, we consider disposable soft contact lenses to be relatively high-risk devices for the cosmetic management of simple myopia, and their continued use must be called into question.