NONULCERATING BACTERIAL KERATITIS ASSOCIATED WITH SOFT AND RIGID CONTACT-LENS WEAR

Objective: An unusual presentation of contact lens-related bacterial k eratitis is that of epithelial nodular infiltrates and stromal inflamm ation without epithelial ulceration, The authors study the initial dia gnosis, clinical features, causative organisms, and outcomes of cornea l infections presenting in this manner. Design: The study design was a 20-month retrospective chart review, Participants: Five patients with culture-proven bacterial keratitis who had predominantly nodular epit helial lesions were studied. Results: Four infections were associated with soft contact lens wear and one with rigid lens wear, All patients had largely intact epithelium; typical gray-colored epithelial nodule s, some with underlying anterior stromal haze; and diffuse, fine, cell ular stromal inflammation. Two patients were referred with the tentati ve diagnosis of Acanthamoeba infection and two as contact lens-related sterile keratitis, Epithelial cultures from three cases yielded Serra tia sp., one yielded Corynebacterium, and one Streptococcus pneumoniae . All responded to antibacterial medication; final corrected visual ac uity in all cases was 20/30 or better. Conclusions: Bacterial infectio n associated with contact lens wear can be established within the corn eal epithelium without initially producing an ulcer. A wide range of b oth gram-positive and gram-negative organisms can be involved. Early r ecognition and treatment appear to result in a favorable outcome.