Infectious keratitis in orthokeratology

Hutchinson, Kenneth; Apel, Andrew

doi:10.1046/j.1442-9071.2002.00483.x

Cited by 58 publications

(49 citation statements)

References 5 publications

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“…This can be detected on slit lamp examination. As superficial keratopathy worsens, the corneal epithelium becomes more permeable [45,46]. Of note, superficial keratopathy has been found in as many as 60% of intubated and sedated ICU patients [3,28].…”

Section: Complications Of Exposure Keratopathymentioning

confidence: 99%

“…One of the most feared complications associated with EK is microbial (or infectious) keratitis, which may lead to perforation, scleritis, endophthalmitis, and even blindness [46,[51][52][53]. In severe cases of corneal infections refractory to maximal medical therapy, treatment of microbial keratitis may require corneal transplantation [52,[54][55][56].…”

Section: Complications Of Exposure Keratopathymentioning

confidence: 99%

See 1 more Smart Citation

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Bird¹,

Dingley²,

Stawicki³

et al. 2018

Vignettes in Patient Safety - Volume 2

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Exposure keratopathy (EK) is a frequently overlooked complication seen in nearly 60% of sedated or intubated intensive care unit (ICU) patients. Signs and symptoms of EK often start as mild subjective complaints of eye pain and irritation, but can progress to vision loss in the most severe cases. For many critically ill patients, the presence of sedation effectively precludes their ability to communicate clinical complaints typically associated with EK. This, combined with the potentially severe sequelae, makes EK a potentially preventable complication and a patient safety issue. Clinical management of EK can be challenging for both providers and patients due to the nature of treatment with eye drops and ointments as well as the burden and expense of associated procedural interventions. Risk factors for EK have been extensively described in the literature, and wider dissemination of this knowledge should facilitate education of physicians and nurses regarding EK prevention. The most common risk factors include lagophthalmos, chemosis, Bell's palsy, and congenital deformities. Additionally, critically ill patients are less likely to be promptly diagnosed due to the focus of staff on life-threatening problems over ocular prophylaxis. However, the potential severity of complications associated with EK mandates that prevention remains a crucial component of the care of at-risk patients. The reader will explore the broad category of adverse medical occurrences included under the umbrella term, "errors of omission" (EOO): an error category that is most likely to culminate in EK. The most critical preventive measure is education of health care providers, although this may not be enough by itself. To this end, universal precautions against EK in combination with education may be used to help combat the relatively high incidence of this easily preventable ocular pathology.

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Section: Complications Of Exposure Keratopathymentioning

confidence: 99%

Section: Complications Of Exposure Keratopathymentioning

confidence: 99%

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Bird¹,

Dingley²,

Stawicki³

et al. 2018

Vignettes in Patient Safety - Volume 2

View full text Add to dashboard Cite

show abstract

“…No significant difference was recognised in the bacterial binding ability to the corneal epithelium between the overnight wear of either conventional or hyper-oxygen transmissible rigid contact lenses. 81 However, central corneal epithelial thinning with visual impairment 82 and the increased risk of bacterial 83,84 and Acanthamoeba keratitis [84][85][86][87][88][89] were reported with the overnight wear of orthokeratology contact lenses.…”

Section: Overnight Sleep In Different Types Of Contact Lensesmentioning

confidence: 99%

How Could Contact Lens Wearers Be at Risk of Acanthamoeba Infection? A Review

Ibrahim

Boase

Cree

2009

Journal of Optometry

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Contact lens wear is highly influential on the incidence of ulcerative keratitis worldwide, particularly in developed countries. The association between Acanthamoeba keratitis and contact lens wear is firmly established; it may account for up to 95% of the reported cases. Before the popularisation of soft contact lens wear, Acanthamoeba keratitis was extremely rare. In 2000 it was estimated that the number of contact lens wearers worldwide was about 80 million, out of whom 33 million were in the United States and 90% of them wore hydrogel soft lenses. Contact lens-related problems depend on many factors, such as lens material, wearing modality, lens hygiene, type of lens-caring solution, the degree of compliance of the lens user with lens wear and care procedures, lens overwear, sleeping in lenses, rate of changing lenses, and lens case hygiene. This paper is a thorough review of the literature aiming to highlight the role of one of the main risk factors of infectious keratitis, contact lens wear, and also to show the responsibility of lens users in aggravating this risk. RESUMENLa utilización de lentes de contacto es un factor que influye sumamente en la incidencia de la queratitis ulcerosa, en particular en los países desarrollados. La asociación entre queratitis por Acanthamoeba y el uso de lentes de contacto está firmemente establecida; podría representar aproximadamente hasta un 95% de los casos registrados. Antes de la popularización del uso de lentes de contacto, la queratitis por Acanthamoeba era muy poco frecuente. En el año 2000 se estimó que, a nivel mundial, había unos 80 millones de usuarios de lentes de contacto, de los cuales 33 millones residían en los Estados Unidos y, de ellos, el 90% utilizaban lentes de contacto blandas de hidrogel. Los problemas derivados del uso de lentes de contacto dependen de otros muchos factores, como el material del que está hecha la lente, la modalidad de uso, las medidas de higiene empleadas, el tipo de solución utilizada para la limpieza y el mantenimiento de la lente, el grado de cumplimiento terapéutico del usuario de las lentes respecto a su utilización y a su limpieza/mantenimiento, el uso de las lentes durante periodos excesivamente prolongados, el dormir con las lentes de contacto puestas, la frecuencia con la que el usuario se cambia de lentes y la limpieza de la funda de las lentes de contacto. Este artículo presenta una revisión minuciosa de la literatura, con el objetivo de resaltar el papel de uno de los principales factores de riesgo de desarrollo de queratitis infeccionsa, como es el uso de lentes de contacto, y con el fin de poner de relieve que el propio usuario de las lentes es, en ocasiones, el responsable de agravar este riesgo. (J Optom 2009;2:60-66 ©2009 Consejo General de Colegios de Ópticos-Optometristas de España) PALABRAS CLAVE: Acanthamoeba; queratitis; lentes de contacto; usuario de lentes de contacto; uso excesivo de las lentes de contacto.

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“…Thus, alterations in the cornea, including corneal epithelial edema, abrasion, and corneal staining can occur, and can predispose the central cornea to an increased risk of infection (Nichols et al, 2000). Orthokeratology lenses, when worn overnight, provide a potential stimulus to this abrasion of microtrauma (Hutchinson and Apel, 2002). Therefore, the mechanism underlying orthokeratology-related infectious keratitis is likely to involve a combination of altered corneal defenses, including microtrauma, hypoxia, and adherence of microorganisms to the corneal epithelium.…”

Section: Discussionmentioning

confidence: 99%

Molecular characterization of Acanthamoeba isolated from amebic keratitis related to orthokeratology lens overnight wear

Jeong

Lee

et al. 2006

Korean J Parasitol

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Abstract:In an effort to characterize, on the molecular scale, the Acanthamoeba initially isolated from the cornea of an amoebic keratitis patient associated with overnight-wear orthokeratology lens in Korea, we conducted mitochondrial DNA restriction fragment length polymorphism, 18S rDNA sequencing, and drug sensitivity analyses on the isolate (KA/PE1). The patient was treated with polyhexamethylene biguanide, chlorhexidine and oral itraconazole, which resulted in resolution of the patient's ocular inflammation. The majority of the molecular characteristics of the KA/PE1 were determined to be identical, or quite similar, to those of A. castellanii Ma strain, which had been isolated also from amoebic keratitis. The risk of Acanthamoeba keratitis as a potential complication of overnight orthokeratology is briefly discussed.

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Infectious keratitis in orthokeratology

Cited by 58 publications

References 5 publications

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

Exposure Keratopathy in the Intensive Care Unit: Do Not Neglect the Unseen

How Could Contact Lens Wearers Be at Risk of Acanthamoeba Infection? A Review

Molecular characterization of Acanthamoeba isolated from amebic keratitis related to orthokeratology lens overnight wear

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