Pathogenesis and treatment of "sterile" midperipheral corneal infiltrates associated with soft contact lens use

To demonstrate the sterile nature of presumed sterile midperipheral corneal infiltrates associated with soft contact lens (SCL) use and to show that w ithholding antibiotics or the occasional use of a topical corticosteroid al one may, with strict guidelines, have a role in the treatment of this entit y. Methods. Nine consecutive patients presenting with typical midperipheral corneal infiltrates after SCL wear were seen in the office (O.H.D.) during a 2-year period, 1996-1998. All patients were initially placed on topical fluorometholone as the only treatment. Results. Eight of the nine patients experienced a rapid relief of symptoms and the infiltrates were noted to be smaller and less dense in 3-4 days. Therapy was discontinued after 7 days, by which time the lesions had cleared. The ninth patient developed a micro bial keratitis from which Pseudomonas aeruginosa was cultured. With appropr iate therapy, visual acuity returned to 20/25. Two different algorithms are offered for the treatment of a putative sterile infiltrate associated with SCL use. Conclusion. The use of a topical corticosteroid alone may have a role in the treatment of presumed sterile midperipheral corneal infiltrates associated with SCLs when strict guidelines are followed. Such therapy sug gests that the infiltrates are not the result of infection.