Therapy for contact lens-related ulcers

Abstract

Purpose of reviewThe current review covers the current literature and practice patterns of antimicrobial therapy for contact lens-related microbial keratitis (CLMK). Although the majority of corneal ulcers are bacterial, fungus and acanthamoeba are substantial contributors in CLMK and are harder to treat due to the lack of commercially available topical medications and low efficacy of available topical therapy.Recent findingsTopical antimicrobials remain the mainstay of therapy for corneal ulcers. Fluoroquinolones may be used as monotherapy for small, peripheral bacterial ulcers. Antibiotic resistance is a persistent problem. Fungal ulcers are less responsive to topical medications and adjunct oral or intrastromal antifungal medications may be helpful. Acanthamoeba keratitis continues to remain a therapeutic challenge but newer antifungal and antiparasitic agents may be helpful adjuncts. Other novel and innovative therapies are being studied currently and show promise.SummaryContact lens-associated microbial keratitis is a significant health issue that can cause vision loss. Treatment remains a challenge but many promising diagnostics and procedures are in the pipeline and offer hope.

The approach to diagnosis and management of corneal ulcers

“…The use of soft contact lenses is most frequently linked to acanthamoeba keratitis. Once firmly connected to the contact lens, it lives in the area between the lens and the ocular surface before eventually adhering to the glycoproteins on the corneal villi (Jeang & Tuli, 2022). Contact lens wear causes microtrauma to the corneal epithelial surface, which facilitates an organism's invasion of the epithelium, Bowman's layer, and stroma.…”

“…In the beginning, a prescription for polyhexamethylene biguanide 0.02% and propamidine isethionate (Brolene) 0.1% may be given. Additionally, effective treatments include chlorhexidine monotherapy and the combination of Brolene and neomycin (Jeang & Tuli, 2022).…”

Spironolactone Eyedrop Favors Restoration of Corneal Integrity after Wound Healing in the Rat

“…A number of diseases or conditions can lead to corneal blindness including mechanical, chemical or photic trauma, infection, and autoimmune, metabolic, and genetic causes. Contact lens wear [4] and refractive surgeries are also common causes of corneal lesions [5]. Chronic corneal ulcerations, often resulting from abnormal wound healing associated with dry eye syndrome, herpetic and diabetic neurotrophic keratopathies [6], and immune-mediated peripheral ulcerative keratitis [7], threaten vision and eventually lead to corneal blindness.…”