Contact Lens-induced Acute Red Eye Research Articles

A Case of Contact Lens Induced Acute Red Eye

Purpose: To report a rare case of acute red eye in a contact lens user.Case summary: An 18-year-old female presented with decreased visual acuity and ocular pain in the right eye for 4 days. The patient had used contact lenses for > 8 hours a day, even while sleeping at night, for the past 3 months. Corneal epithelial edema and punctate stromal infiltration along with diffuse conjunctival hyperemia and corneal limbal injection in the right eye were observed in slit lamp examination. The uncorrected and corrected visual acuities of the right eye were 0.02 (20/1000) and 0.16 (20/125), respectively. The right eye had an intraocular pressure of 10 mmHg, and the left eye was within normal range. The patient stopped wearing contact lenses and was prescribed steroid and antibiotic eye drops and artificial tears. The corrected visual acuity increased to 0.5 (20/40) on the first day of treatment and to 1.0 (20/20) after 2 months. The cornea and conjunctiva also returned to the normal appearance.Conclusions: It is important to differentiate contact lens-induced acute red eye from microbial keratitis. Discontinuation of contact lens use and education are required to prevent acute red eye caused by contact lens use.

Contact Lens-induced Acute Red Eye

It is important to understand the acute and chronic complications of prolonged contact lens use; treatment of acute problems is more effective than treatment of chronic reactions because it is difficult to restore corneal tissue. Contact lens-induced acute red eye (CLARE) is an acute inflammatory reaction of the cornea and conjunctiva triggered by contact lenses. CLARE recurrence is common; differential diagnosis from serious eye diseases that can compromise visual acuity is important. CLARE must be appropriately treated and patients must be educated in terms of safe contact lens wearing and storage.

Safety and Efficacy of Scleral Lenses for Keratoconus.

SIGNIFICANCEThis study affirms the long-term safety and efficacy of scleral contact lens use in patients with keratoconus.PURPOSEThis study aimed to evaluate the safety and efficacy of contemporary scleral contact lenses in the visual rehabilitation of the keratoconic population.METHODSA retrospective study of keratoconic subjects examined between 2013 and 2018 was conducted. Subjects were included regardless of age, sex, pre-existing morbidity, or scleral lens design. Only eyes fit successfully with scleral contact lenses for ≥1 year were included. Exclusion criteria were prior corneal surgery, dystrophy, degeneration, and trauma.RESULTSA total of 157 eyes of 86 subjects met the study criteria. The mean Keratoconus Severity Score at initial fitting was 3.6 ± 1.0. Lenses were gas-permeable and nonfenestrated, with a mean overall diameter of 15.8 ± 0.6 mm and 70.1% toric scleral periphery. Physiological adverse events occurred in 9.6% of eyes, including microbial keratitis (0.6%), phlyctenulosis (0.6%), corneal abrasion (1.3%), contact lens–induced acute red eye (1.3%), corneal infiltrative events (1.3%), pingueculitis (1.3%), and hydrops (3.2%). Lens-related adverse events were documented in 55.4% of eyes. Adverse events related to surface issues included poor wetting in 1.9%, handling in 3.8%, reservoir fogging in 7.0%, lens intolerance in 7.6%, deposit in 8.9%, and broken lenses in 26.1% of eyes. The most common management strategies involved refits (54.0% of interventions), patient reeducation (29.5%), medical treatment (5.5%), surgical referral (6.8%), adjustment to wear time (2.5%), surface treatment (1.2%), and lens replacement (0.6%). Best-corrected distance logMAR visual acuity improved significantly from a mean of 0.50 in spectacles to a mean of 0.08 in scleral lenses (P < .0001). During the study period, 14.6% of eyes lost best-corrected scleral lens visual acuity, all from keratoconus progression.CONCLUSIONSConsistent with other groups, our study demonstrates excellent safety and efficacy of scleral contact lenses in subjects with keratoconus.

External Ocular Surface and Lens Microbiota in Contact Lens Wearers With Corneal Infiltrates During Extended Wear of Hydrogel Lenses

To determine whether carriage of microbes on the contact lens or ocular surfaces during extended wear (EW) with soft hydroxyethyl methacrylate (HEMA)-based contact lenses predisposes the wearer to adverse events. Participants (non-contact lens wearers) were enrolled in a clinical study involving wear of HEMA-based hydrogel lenses on a six night EW basis with weekly replacement. Type and number of bacteria colonizing the lower lid margins, upper bulbar conjunctiva, and contact lenses during EW after one night, 1 week, 1 month, and thereafter every 3 months for 3.5 years were determined. The association of bacteria with adverse responses was compared between carriers (defined as having significant microbes cultured from two or more samples with 1 year) and noncarriers, and the strength of the association was estimated using multivariate logistic regression. Carriers of gram-positive bacteria on lenses (particularly coagulase negative staphylococci or Corynebacterium spp.) were approximately three and eight times more likely to develop contact lens-induced peripheral ulcers (CLPUs) and asymptomatic infiltrates (AIs), respectively. Staphylococcus aureus was most frequently isolated from lenses during CLPU. Carriers of gram-negative bacteria on lenses were five times more likely to develop contact lens-induced acute red eye (CLARE). Haemophilus influenzae was isolated most frequently from lenses during CLARE and AI events. Bacterial carriage on contact lenses during EW predisposes the wearer to the development of corneal inflammatory events including CLARE, CLPU, and AI.

In Vivo Performance of Melimine as an Antimicrobial Coating for Contact Lenses in Models of CLARE and CLPU

One strategy to minimize bacteria-associated adverse responses such as microbial keratitis, contact lens-induced acute red eye (CLARE), and contact lens induced peripheral ulcers (CLPUs) that occur with contact lens wear is the development of an antimicrobial or antiadhesive contact lens. Cationic peptides represent a novel approach for the development of antimicrobial lenses. A novel cationic peptide, melimine, was covalently incorporated into silicone hydrogel lenses. Confirmation tests to determine the presence of peptide and anti-microbial activity were performed. Cationic lenses were then tested for their ability to prevent CLPU in the Staphylococcus aureus rabbit model and CLARE in the Pseudomonas aeruginosa guinea pig model. In the rabbit model of CLPU, melimine-coated lenses resulted in significant reductions in ocular symptom scores and in the extent of corneal infiltration (P < 0.05). Evaluation of the performance of melimine lenses in the CLARE model showed significant improvement in all ocular response parameters measured, including the percentage of eyes with corneal infiltrates, compared with those observed in the eyes fitted with the control lens (P < or = 0.05). Cationic coating of contact lenses with the peptide melimine may represent a novel method of prevention of bacterial growth on contact lenses and consequently result in reduction of the incidence and severity of adverse responses due to Gram-positive and -negative bacteria during lens wear.

Are Inflammatory Events a Marker for an Increased Risk of Microbial Keratitis?

To consider whether inflammatory events, such as contact lens-induced peripheral ulcers, contact lens-induced acute red eye, and infiltrative keratitis are a marker for an increased risk for the occurrence of microbial keratitis. A review of relevant studies was undertaken with the view to answering two questions: 1) Do inflammatory events associated with contact lens wear progress to infection or microbial keratitis; and 2) Do episodes of inflammatory events predispose a patient to having an event of microbial keratitis? The large body of laboratory work, along with the epidemiologic data on incidence rates and clinical data with regard to differences between the nature of inflammatory events and infection, supports the supposition that inflammatory events are not a marker for increased risk of microbial keratitis. Inflammatory events are not a marker for increased risk of microbial keratitis, nor will they progress to infection because they are separate disease entities.

Can Subtypes of Contact Lens-Associated Corneal Infiltrative Events Be Clinically Differentiated?

A schema has recently been described for clinical differentiation among 4 symptomatic subtypes of contact lens-associated corneal infiltrative events (CIEs): microbial keratitis (MK), contact lens-induced peripheral ulcer (CLPU), contact lens-induced acute red eye (CLARE), and infiltrative keratitis (IK). The clinical utility of this schema has been challenged in the literature. The aim of this study is to determine whether it is possible to clinically differentiate among these conditions. Criteria for MK, CLPU, CLARE, and IK were applied to a data set of 111 contact lens-associated CIEs, spanning a wide range of clinical severities, presenting consecutively to a hospital clinic. A Venn diagram analysis was used to determine the extent to which these conditions can be clinically differentiated. Of the 111 CIEs, 20% could be classified unambiguously as MK, CLPU, CLARE, or IK, 56% could be classified as 1 of 2 conditions, 13% could be classified as 1 of 3 conditions, and 0% could be classified as 1 of 4 conditions. Eleven percent of CIEs could not be classified as any of the 4 conditions. Although the etiology of CIEs is multifactorial, the considerable overlap between the clinical presentation of MK, CLPU, CLARE, and IK is such that it is not possible to clinically differentiate between them with any degree of certainty. A preferred approach might be to consider CIEs as part of a disease continuum whereby these events can manifest in various degrees of severity, depending as well on the point at which the condition is observed in the course of the natural history of the disease.

Induction of cytokines from polymorphonuclear leukocytes and epithelial cells by ocular isolates of Serratia marcescens

Purpose: During contact lens wear, bacterial contamination of the lens can lead to the development of microbial keratitis (MK) or contact lens induced acute red eye (CLARE). Inflammatory mediators released by the host may heighten the response. We have examined the ability of human corneal epithelial cells and polymorphonuclear leukocytes (PMNs) to release cytokines upon stimulation with bacteria. Methods: Serratia marcescens strains were added to corneal epithelial cells or PMNs. After incubations of up to 20 hours, supernatants were assayed for the presence of inflammatory mediators by ELISA. Results: All strains stimulated PMNs to release IL-8 and LTB4. Epithelial cells did not release LTB4. IL-8 was released after exposure to most S. marcescens isolates. A sub-group of strains stimulated the release of TNF-α from corneal epithelial cells. Conclusions: S. marcescens can stimulate the release of inflammatory mediators from both PMNs and corneal epithelial cells. This release could be important in the progression and resolution of MK and CLARE.

Isolation of conjunctival mucin and differential interaction with Pseudomonas aeruginosa strains of varied pathogenic potential

The purpose of the study was to investigate the adhesion of Pseudomonas aeruginosa strains with varying pathogenic potential to purified ocular mucin. Bovine conjunctival mucin was purified by three sequential density gradient centrifugation steps. Immobilised mucin was probed with biotin-labelled bacteria isolated from different contact lens events and quantified by densitometry. Bacterial pili were identified by electron microscopy. The results indicate that purified ocular mucin consisted of a polydisperse high molecular weight population containing at least one species of goblet cell origin and was associated with a 97 kDa mucin-associated protein. Three pathogenic P. aeruginosa strains, Paer1 (57·5±10·8×10 6 CFU ml −1; contact lens induced acute red eye (CLARE)), 6294 (127·0±4·7×10 6 CFU ml −1; microbial keratitis) and Paer25 (60·5±11·3×10 6 CFU ml −1; CLARE) exhibited a significantly higher level of adhesion to mucin than the negative control, E. coli (14·3±9·6×10 6 CFU ml −1) ( p<0·005). The remaining P. aeruginosa isolates, Paer3 (asymptomatic patient), Paer12 (microbial keratitis) and ATCC15442 (standard environmental strain) did not significantly differ in their mucin adhesion from the negative control. The majority of bacterial strains tested contained pili; thus differences in mucin adhesion observed could not be solely explained by pili status. In conclusion, P. aeruginosa isolates exhibit differential adhesion patterns to purified ocular mucin. It is proposed that more avid mucin-adhering strains are given the opportunity to adhere and subsequently penetrate the mucous layer of the tear film to initiate pathogenesis.

Clinical characterization of corneal infiltrative events observed with soft contact lens wear.

Corneal infiltrates are commonly observed during adverse reactions associated with contact lens wear. Broad ranges of presentations are encountered, and there is no well-established classification system. The aim of this paper is to categorize corneal infiltrates associated with soft lens wear and present the typical clinical characteristics associated with each type of event. All events of corneal infiltrates occurring in soft contact lens clinical trials over 10 years (9 years retrospective and 1 year prospective) and conducted at two contact lens research centers were reviewed by a panel of experts comprising ophthalmologists, optometrists, and other biologic scientists. Classification of each event was based on assessment of a range of signs and symptoms by the review panel. A classification scheme was devised to distinguish infiltrative events that were serious and symptomatic (microbial keratitis), clinically significant and symptomatic (contact lens-induced peripheral ulcer, contact lens-induced acute red eye, infiltrative keratitis), and clinically nonsignificant and asymptomatic (asymptomatic infiltrative keratitis and asymptomatic infiltrates). Corneal infiltrates can be classified into six distinct categories. This classification scheme, based on clinical characteristics, should aid diagnosis, management, and treatment of corneal infiltrates as well as assisting investigations into the etiology of each of these conditions.

Evasion of cellular ocular defenses by contact lens isolates of Serratia marcescens.

Contact lens contamination by Serratia marcescens can lead to the development of microbial keratitis and contact lens-induced acute red eye, particularly during overnight contact lens wear. The aim of this study was to investigate the interaction of S. marcescens with polymorphonuclear leukocytes (PMNs), which occur in closed-eye tears. The respiratory burst of PMNs, when incubated with S. marcescens, was measured using chemiluminescence. Phagocytosis of planktonic and biofilm-grown bacteria by PMNs was also determined. Some strains of S. marcescens did not induce a respiratory burst from PMNs and resisted phagocytosis regardless of opsonization. Phagocytic resistance and growth in the presence of PMNs was markedly increased when bacteria were grown as a biofilm on a contact lens. The ability of S. marcescens to resist phagocytosis and grow to high levels in the presence of PMNs, particularly when grown as a biofilm on contact lenses, may be a mechanism by which this bacterium can survive the ocular host defense system, grow, and cause keratitis or other adverse responses.

Balance of pro- and anti-inflammatory cytokines correlates with outcome of acute experimental Pseudomonas aeruginosa keratitis.

The purpose of this study was to elucidate the expression of pro- and anti-inflammatory cytokines in mouse corneas infected with Pseudomonas aeruginosa. Three bacterial strains (invasive, cytotoxic, or CLARE [contact lens-induced acute red eye]) which have recently been shown to produce distinct patterns of corneal disease in the mouse were used. The left mouse (BALB/c) corneas were scarified and infected with 2 x 10(6) CFU of one of the three P. aeruginosa strains, while right eyes served as controls. Animals were examined at 1, 4, 8, 16, and 24 h with a slit lamp biomicroscope to grade the severity of infection. Following examination, eyes were collected and processed for histopathology, multiprobe RNase protection assay for cytokine mRNA, enzyme-linked immunosorbent assay to quantitate cytokine proteins, and myeloperoxidase activity to quantitate polymorphonuclear leukocytes. The kinetics of appearance and magnitude of expression of key cytokines varied significantly in the three different phenotypes of P. aeruginosa infection. The predominant cytokines expressed in response to all three phenotypes were interleukin-1 beta (IL-1 beta), IL-1Ra, and IL-6. In response to the invasive strain, which induced severe corneal inflammation, significantly lower ratios of IL-1Ra to IL-1 beta were present at all time points, whereas corneas challenged with the CLARE strain, which induced very mild inflammation, showed a high ratio of IL-1Ra to IL-1 beta. The outcome of infection in bacterial keratitis correlated with the relative induction of these pro- and anti-inflammatory cytokines, and exogenous administration of recombinant rIL-1Ra (rIL-1Ra) was able to reduce the disease severity significantly. These findings point to the therapeutic potential of rIL-1Ra protein in possible treatment strategies for bacterial keratitis.

Contact lenses and tear film interactions.

Contact lenses are a successful form of vision correction. However, under certain circumstances adverse inflammatory responses can occur during lens wear. These inflammatory responses can be divided into those that involve the cornea and conjunctiva, and those that are primarily conjunctival. The former category includes microbial keratitis, contact lens-induced acute red eye, contact lens-induced peripheral ulcers, infiltrative keratitis, asymptomatic infiltrative keratitis and asymptomatic infiltrates. These conditions have recently been described in detail, and many are produced by bacterial contamination of contact lenses.1-4 The major contact lens-related inflammatory conditions primarily associated with the conjunctiva are contact lens-induced papillary conjunctivitis (CLPC), and the more severe form of this disease, giant papillary conjunctivitis (GPC). However, the etiology of these conditions is poorly understood. The aim of the current study is to examine the effect of contact lens wear on tear proteins and determine which and how much specific tear proteins are adsorbed to the contact lens during wear.

Decay-Accelerating Factor in Tears of Contact Lens Wearers and Patients with Contact Lens-Associated Complications

Complement activation fragments have been detected in the anterior segment during 1) eye closure, 2) contact lens wear, and 3) in some contact lens-associated pathologies. The decay-accelerating factor (DAF), a membrane-associated complement regulatory protein that inhibits the central C3 amplification convertases of the cascade, is present on both the ocular surface and in tears. In this study, we measured levels of tear DAF in asymptomatic contact lens patients and in patients who presented with contact lens-associated complications. Tears were collected from 55 patients using capillary pipettes. Subjects included normal non-contact lens wearing controls (N = 14), asymptomatic soft (N = 13) and rigid gas permeable (N = 5) wearers, and individuals with contact lens-induced acute red eye (CLARE) (N = 4), ulcerative keratitis (N = 3), giant papillary conjunctivitis (GPC) (N = 8), contact lens peripheral ulcers (N = 3), and infiltrative keratitis (N = 5). Levels of DAF were assessed using a two-site immunoradiometric assay using anti-DAF monoclonal antibodies. The mean concentration of DAF in normal controls was found to be 149+/-78 ng/ml, 117+/-59 ng/ml, and 111+/-86 ng/ml for noncontact lens patients, and asymptomatic soft and rigid gas permeable lens wearers, respectively. In the conditions of CLARE, infiltrative keratitis, and GPC, DAF concentrations were significantly reduced compared with normal noncontact lens controls. Compared with asymptomatic soft lens patients, the condition of infiltrative keratitis showed a significant reduction in tear DAF. This study documents a trend toward decreased levels of tear DAF in patients with the contact lens associated inflammatory conditions CLARE, GPC, and infiltrative keratitis. Tears of patients with infiltrates show the most significant reduction of tear DAF. The reductions may be associated with enhanced complement activation contributing to the pathogeneses of infiltrative keratitis and associated ocular surface diseases.

A Pseudomonas aeruginosa strain isolated from a Contact Lens-Induced Acute Red Eye (CLARE) is protease-deficient

A Pseudomonas aeruginosa strain isolated from a Contact Lens-Induced Acute Red Eye (CLARE) is protease-deficient

A Pseudomonas aeruginosa strain isolated from a Contact Lens-Induced Acute Red Eye (CLARE) is protease-deficient

Purpose. Pseudomonas aeruginosa proteases are thought to be important virulence factors in the pathogenesis of corneal disease. This study examined protease production from two strains of P. aeruginosa responsible for two very distinct clinical diseases: strain Paer1, isolated from a C ontact L ens-induced A cute R ed E ye (CLARE), and strain KEI 1025, isolated from a corneal ulcer. Strains were compared to a laboratory strain (ATCC 19660) known to produce severe keratitis in experimentally infected mice for protease production and for ocular virulence. Methods. Protease production was examined with colorimetric assays, gelatin zymography and western blots. Elastase A activity was quantitated with a staphylolytic assay. Ocular virulence was examined using a mouse scratch model of keratitis. Results. In contrast to strains KEI 1025 or ATCC 19660, Paer1 was unable to produce enzymatically active elastase A, elastase, and protease IV. All three strains produced active alkaline protease. Strains KEI 1025 and ATCC 19660 produced a fulminant keratitis in mice whereas Paer1 produced a mild transient infection. Restoration of elastase activity in Paer1 via genetic complementation did not result in a virulent phenotype. Co-infection of mouse eyes with strains Paer1 and ATCC 19660 resulted in the eventual loss of Paer1 from corneal tissue. Conclusions. These studies suggest that P. aeruginosa elastase A and/or protease IV, but not alkaline protease or elastase, contribute to the ocular virulence of this organism.

Expression of interleukin-6 in the cornea in response to infection with different strains of Pseudomonas aeruginosa.

Strains of Pseudomonas aeruginosa causing keratitis can be either cytotoxic (6206) or invasive (6294), while a strain (Paer1) causing contact lens-induced acute red eye has been shown to be neither. In situ hybridization was used to examine the location and identity of cells expressing interleukin-6 (IL-6) mRNA in the murine cornea and changes in expression in response to infection with different strains of P. aeruginosa. The number of IL-6-positive cells was determined by image analysis. IL-6 protein levels were measured by an enzyme-linked immunosorbent assay. BALB/c mice were challenged by use of the wounded-cornea model with P. aeruginosa 6294, 6206, or Paer1 (2 x 10(6) CFU). At time intervals up to 24 h, postchallenge corneal tissue was probed for IL-6 mRNA. IL-6 mRNA expression was rapidly elevated in the epithelium in response to strains 6294 and 6206. At the conclusion of the experiments, infiltrating inflammatory cells also stained positively for IL-6 mRNA. In contrast, corneas challenged with strain Paer1 showed significant upregulation of IL-6 mRNA only at 4 h postchallenge. Three distinct patterns of IL-6 mRNA expression in the mouse cornea occur in response to these three ocular isolates of P. aeruginosa. The data obtained for mRNA expression in the cornea for all three strains of P. aeruginosa correlated well with IL-6 protein analysis of whole-eye homogenates. Differences in the cytokine responses to these strains correlate with differences in the pathology associated with each strain and may offer an opportunity to develop strategies for the improved management of ocular inflammation.

TNF-alpha production in the cornea in response to Pseudomonas aeruginosa challenge.

Pseudomonas aeruginosa can cause ulcerative bacterial keratitis or contact lens-induced acute red eye (CLARE) in humans. The present study used a mouse model of ocular infection and inflammation to examine the relationship between TNF-alpha and inflammation in the cornea in response to challenge with either a strain of P. aeruginosa causing keratitis or a CLARE strain. Constitutive TNF-alpha mRNA was detected in the epithelium, mainly towards the periphery. After infection with the keratitis-inducing strain (6294), TNF-alpha expression was elevated four-fold by 24 h post-challenge. No detectable induction of TNF-alpha mRNA was seen with CLARE strain (Paer1) challenge at any time point. The TNF-alpha protein production detected by ELISA showed a corresponding pattern to the mRNA expression, which also correlated with pathological changes. These results suggest that invasive strains of P. aeruginosa create greater pathological changes as a result of elevated TNF-alpha production, which contributes to inflammation during keratitis in vivo.

Cytokine and Lipid Inflammatory Mediator Profile of Human Tears During Contact Lens Associated Inflammatory Diseases

Contact lens induced acute red eye (CLARE) and contact lens induced peripheral ulcer (CLPU) are among the most common contact lens induced inflammatory reactions. Both CLARE and CLPU are characterized by corneal infiltration which indicates the presence of chemoattractants and other inflammatory mediators. The aim of this study was to characterize the cytokine and chemotactic lipid inflammatory mediator profile in the tears of people experiencing CLARE or CLPU. Cytokines IL-1β, IL-6, IL-8, GM-CSF and LTB4in tears were measured by antibody sandwich and competition inhibition enzyme-linked immunosorbent assays (ELISA). Platelet activating factor-like activity was measured by a degranulation assay by measuring the release of labelled serotonin from platelets. The functional role GM-CSF and chemoattractants were determined by flow cytometry and chemotaxis. Increased levels of cytokines and chemoattractants were detected in both CLARE and CLPU tears. CLPU tears showed increased levels of LTB4(P=0.002) and PAF-like activity (P=0.047)whereas CLARE tears showed increased levels of GM-CSF (P=0.002), IL-8 (P<0.05), LTB4(P=0.002) and PAF-like activity (P=0.047) compared to>control tears. Flow cytometric analysis revealed that incubation of PMN with CLARE tears increased the number of IgA receptors indicating that the GM-CSF in CLARE tears was active. Combinations of suboptimal concentrations (which were found in CLARE and CLPU tears) of IL-8 with either LTB4or PAF significantly (P<0.0001) enhanced the chemotactic activity for PMN compared to their individual effects. Our data highlight the possible pathophysiological roles of these inflammatory mediators in leukocyte recruitment and activation during ocular inflammatory responses. The results suggests that GM-CSF, IL-8 and LTB4are active during corneal pathology and LTB4or IL-8 may maintain the contact lens induced PMN response in vivo.

Different strains of Pseudomonas aeruginosa isolated from ocular infections or inflammation display distinct corneal pathologies in an animal model

Purpose. The present investigation sought to define the responses of mouse eyes to challenge with three different strains of P. aeruginosa isolated from human corneas or contact lenses: two different strains produced an ulcerative keratitis, and one strain produced contact lens-induced acute red eye (CLARE).Methods. The corneas of BALB/c mice were inoculated with three different strains of P. aeruginosa. The strains were allowed to interact with the corneas for up to 24 h. In addition, strain Paerl, isolated from CLARE, was subjected to in vitro assays to measure its ability to invade corneal epithelial cells, or to produce cytotoxicity in these cells. Both these assays used cultured rabbit corneal epithelial cells.Results. Both MK isolates were able to infect the corneas of mice, but the CLARE isolate was non-infective. The predominant response to infection with the cytotoxic strain was severe corneal edema and infiltration of the corneal stroma with polymorphonuclear leukocytes (PMNs). The predominant response with the invasive MK isolate was corneal ulceration and infiltration with PMNs. The CLARE strain produced only low levels of PMN infiltration. In in vitro assays the CLARE strain was non-invasive and non-cytotoxic.Conclusions. This study has identified that P. aeruginosa produces at least three different types of corneal pathology and that not all strains are able to infect mouse corneas. Curr. Eye Res. 17:730–735, 1998.