Patients with suspected ulcers or contact lens keratitis should be referred to ophthalmology for further management and investigations
Always have a high level of suspicion in patients who wear contact lenses if they present with a painful red eye. Consider keratitis even if they have had an injury suggesting abrasion/foreign body. They require examination under slit lamp by an experienced optometrist/ophthalmologist to rule out contact lens keratitis. This tends to be a small circular lesion which stains with fluorescein.
Recommendations to contact lens wearers include washing hands prior to inserting lenses. Having contact lens free days each week and ensuring lenses are not worn for longer than 8-10 hours a day are important to prevent corneal hypoxia. Avoid swimming and showering in contact lenses as these increase the risk of acanthamoeba infection. Prescription goggles/sunglasses at a reasonable price are available online/from high street optometrists.
Patients with these conditions will present with a painful red eye, gritty sensation and photophobia. If pain is severe and out of proportion to what is seen with fluorescein staining acanthamoeba should be considered.
If a contact lens wearer develops conjunctivitis they should avoid lenses until this completely clears up as this increases the risk of a secondary keratitis.
Following treatment for a contact lens related infection lenses should not be resumed until follow up with an optometrist. They may advise different lenses and less frequent use.
In some cases patients with corneal ulcers require admission to the ward for intensive hourly antibiotic drops.
