Risk factors for contact lens-related microbial keratitis: A case-control multicenter study

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The most feared complication of contact lens (CL) wear is microbial keratitis (MK), even though its incidence remains low. While CL materials and replacement schedules have developed greatly in recent years, the risk of MK, however, has not been reduced in users of daily disposable and silicone hydrogel CL. This study aimed to identify the risk factors of CL-related MK while putting into perspective individual patients’ risks and societal burdens.


A multicenter case-control study was designed. The CL-related MK subpopulation (Case) was compared to healthy CL wearers (Control) using a complete a 52-item anonymous questionnaire designed to determine subject demographics and lens wear history. Univariate and multivariate logistic regression analyses were performed in order to compare both groups.


The study enrolled 508 cases and 499 controls, and revealed a higher risk for MK patients wearing soft CL, with cosmetic CL, with overnight wear, exceeding the CL- or the cleaning solution replacement delay, using a multipurpose cleaning solution. On the contrary, hyperopia, fitting and follow-up by an ophthalmologist, and respect of basic hygiene rules were protective against CL-related MK.


The infectious determinants were linked to the patient, type of lenses, hygiene routine, CL handling, cleaning solution, and storage case. This study aimed to highlight the increasingly documented CL-associated complications, which likely occur due to insufficient health professional supervision and lack of patient information regarding basic rules of hygiene, as well as CL care and handling.

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