Contact Lenses and Infectious Keratitis

Abstract

We review the evolution of contact lenses, risk factors for contact lens-related infectious keratitis, and updates on management. Infectious keratitis is still a devastating complication of contact lens use, with improper lens hygiene and use as significant risk factors. Cosmetic contact lenses have become popular among the younger generations. They can be obtained online without a doctor’s prescription or supervision, leading to an increased risk of serious infection. Topical antibiotics remain the best treatment for bacterial keratitis, but resistance to fourth-generation fluoroquinolones has increased. Fungal ulcers fare worse than bacterial ulcers, with no new commercially available topical treatments since topical natamycin. Despite the well-established link between water exposure of contact lenses and development of Acanthamoeba keratitis, patients still regularly expose their lenses to tap water. Corneal cross-linking, new methods for antimicrobial drug delivery, and novel antimicrobial targets represent the next frontiers in the treatment of infectious keratitis. Contact lens-related infectious keratitis remains a serious cause of ocular morbidity, with the rates of atypical causative organisms (Acanthamoeba and fungus) on the rise. Strategies for risk reduction include prevention through patient education; collaboration with industry to develop novel antimicrobials, lens materials, and care system products; and reporting of infections and illegal sale of contact lenses to regulatory agencies such as the United States Food and Drug Administration (FDA) and the Federal Trade Commission (FTC).