Contact Lens Induced Corneal Ulcers; a Series of a Considerable Risk Factor

Corneal ulcers are a major cause of blindness worldwide. A recent eye health care concern is the increasing incidence of contact lens induced corneal ulcers. Delay in the diagnosis and management of corneal ulcers can cause severe visual loss, therefore an early ophthalmologist visit and timely administration of antimicrobial agents can prevent visual loss. Factors associated with increased risk of contact lens related corneal ulcers include overnight wear, long duration of continuous wear, lower socioeconomic status, smoking, dry eye and poor hygiene.1-3 During the summer of 2010, five patients with soft contact lens induced corneal ulcers (Figure 1) were referred to Imam Hossein Medical Center. The denominator in all subjects was purchase of the contact lenses from nonprofessionals such as beauty salons and lack of information regarding contact lens hygiene, disinfection and use. After history taking and clinical examination, smear and culture tests were performed; all patients were admitted and received broad spectrum antibiotics. The symptoms, signs, results of eye examination and corneal culture were recorded. Mean age of the patients was 19 years and all subjects were otherwise healthy. All patients except one had used cosmetic soft contact lenses. Culture results revealed pseudomonas in 3 cases, pneumococcus in one patient and acanthamoeba in another case. The subject with acanthamoeba keratitis (Figure 2) had initially been diagnosed as a case of herpes simplex keratitis, however a correct diagnosis was established with confocal scan. This patient underwent urgent keratoplasty due to descemetocele formation and impending perforation (Figure 3). Two patients sustained moderate visual loss due to central corneal scar formation (Figure 4) following resolution of the infection and the two other cases had relatively good final visual acuity. The use of contact lenses for refractive, cosmetic and therapeutic purposes has increased over the past decades due to improvements in contact lens design and material.4 Convenience, comfort and cosmetics are major reasons for using contact lenses.4,5 Common complications