Pathogenesis and Treatment of “Sterile” Midperipheral Corneal Infiltrates Associated with Soft Contact Lens Use


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Abstract

Purpose.To demonstrate the sterile nature of presumed sterile midperipheral corneal infiltrates associated with soft contact lens (SCL) use and to show that withholding antibiotics or the occasional use of a topical corticosteroid alone may, with strict guidelines, have a role in the treatment of this entity.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 microbial keratitis from which Pseudomonas aeruginosa was cultured. With appropriate 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 suggests that the infiltrates are not the result of infection.

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