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Severe bilateral Pseudomonas keratitis exacerbated by prolonged contact lens wear

- Featured Image

Clinical record

A 28-year-old man with a 4-day history of bilateral ocular pain and a 2-day history of bilateral vision loss and purulent discharge was referred by a local hospital to our tertiary hospital. At the time of symptom onset, he had been wearing prescription monthly wear silicone hydrogel contact lenses (for correction of myopia) while swimming in lakes in Banlung in north-east Cambodia. The pain had worsened over 24 hours and the patient thought he had removed his contact lenses. He was prescribed topical neomycin 0.3% to use 2-hourly and topical moxifloxacin 0.5% to use three times a day in both eyes, and advised to return to Australia for follow-up. He had no prior medical problems.

On examination, both contact lenses were still in situ and the patient had only light perception. There was conjunctival and ciliary injection, with peripheral thinning of both corneas, especially in the inferior areas (Figure, A and B). Both corneas were completely white and opaque, owing to dense corneal infiltrations involving the whole cornea. Subtotal epithelial defects were seen with 1.5 mm hypopyon in both eyes.

The contact lenses were removed immediately. Both eyes were then treated empirically with hourly topical cephazolin 5% and gentamicin 1.5%, topical prednisolone acetate 1% six times a day and topical cyclopentolate 1% three times a day. Preservative-free lubricant (white soft paraffin [57.3%…