Preventing Contact Lens-Related Microbial Corneal Inflammation (Keratitis)

Many factors work against contact lens wearers, so a robust strategy is needed to reduce their bioburden.

By: Christine W. Sindt, OD, FAAO

Contact lens-related microbial keratitis is all too common. Consider these statistics:

  • Contact lens wear is the single greatest risk factor for microbial keratitis, with an annual cost of $175 million.
  • There are 40.9 million adult contact lens wearers in the United States — that’s one in six adults.
  • Nearly one-third of contact lens wearers have had a red or painful eye at some point that required them to go to the doctor since they began wearing contact lenses.
  • A remarkable 99% of contact lens wearers report having at least one poor hygiene behavior that puts them at greater risk for microbial keratitis or a cornea infiltrative event.

In the decades since we have been prescribing contact lenses, the incidence of microbial keratitis has not improved. That means that all the advances in lens materials and solutions have not reduced the incidence — which indicates that microbial keratitis and other inflammatory events must be caused by something that is naturally introduced into the eye.

All these risk factors point to the need to control the bioburden on our contact lens patients. In particular, we need to address the bacteria that most commonly cause microbial keratitis events: Pseudomonas, Serratia, and Staphylococcus. Pseudomonas is a gram-negative, biofilm-forming bacterium that adapts to different environments and may acquire solution resistance. It produces toxins and causes inflammatory events. Staphylococcus is gram positive. It exists in normal external ocular microbiota, and we see it commonly in contact lens peripheral ulcers. If patients have an abundance of any of these microorganisms in their lid margins, they are likely to experience microbial keratitis.  

Case Study

We see these cases all the time. A 32-year-old woman has irritated eyes for three days, and then wakes up with red, pain-ful eyes and photophobia. She is a contact lens wearer, and swears that she does not sleep in her contact lenses. Our examination does not show any true ulceration, but there is a lot of staining along the lid margin, so it’s clear that the eyelid areas are the source of the irritation.

Once we start the patient on moxifloxacin (Vigamox, Alcon) and prednisolone (Pred Forte, Allergan), along with Avenova, her eyes improve quickly and significantly. This tells us that this is an inflammatory process caused by the toxins from bacteria along her lid margins. After one week, the patient’s red eyes resolve completely. She continues with Avenova and we fit her for daily disposable contact lenses.

Approaching Lid Hygiene with Avenova

What does this mean to the 32-year-old patient with contact lens-related microbial keratitis originating in her eyelids? As we work to control the flora introduced into the contact lens wearer’s eye, lid hygiene is a key initiative. Staph isolates from eyelids of contact lens wearers are genetically more resistant to disinfection and antibiotics than isolates from people who don’t wear contact lenses. The longer a patient wears contact lenses, the more resistant the lenses may become to cleaning and disinfecting.

Avenova® a pure hypochlorous acid product by NovaBay, does not build up resistance. It uses a patented, pure, non-cytotoxic hypochlorous acid, a substance that occurs naturally in the immune system, to counteract bacteria living on the eyelids.

I recommend all contact lens wearers wipe down their lids with Avenova® before and after contact lens wear. The product is gentle and comfortable and takes just a few minutes to use.  Christine W. Sindt, OD, FAAO, is the Director of the Contact Lens Service and a Clinical Associate Professor at the University of Iowa, Department of Ophthalmology and Visual Sciences. She is also a consultant for NovaBay.

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