If you wear contact lenses and you ever wake up with a painful red eye with discharge or blurred vision, you should always consider the possibility of a corneal infection.
A corneal abrasion is a small scratch on the outermost layer of the cornea. If there is significant trauma to the eye or infection within deeper layers of the cornea, you may have a corneal ulcer or infectious keratitis which is similar to an “open sore.” This occurs when there is a breakdown in the cornea and microbes create an infection within the eye. Typically, a small section of the transparent tissue will look white or gray. The cornea is the transparent window into the eye, and it is critical for this segment to remain healthy and intact so that you can see everything clearly.
A corneal ulcer is most commonly caused by bacteria and fungal infections, though it can occur in anyone who has sustained a direct eye injury. The trauma creates an entry point for bacteria or other microorganisms to invade and establish an infection.
Contact lens wearers have a significantly higher risk of developing a corneal ulcer. This is especially true for individuals who wear extended duration contacts as they are ten times more likely to develop an infection. They are also susceptible to microtrauma that can occur from the lens itself. With extended wear, contact lenses can develop small scratches at the edge or deposits that can lead to this microtrauma. In addition, contacts can harbor bacteria on the surface over time. Lastly, these contact lenses can obstruct oxygen availability and thus make the cornea more susceptible to infection. Wearing contacts overnight is also associated with a higher risk of infection.
Ulcers can also occur due to other microorganisms. The herpes virus, commonly associated with cold sores, can lead to recurrent corneal ulcers. Contact wearers are at higher risk for a fungal or parasitic infection. One example is Acanthamoeba, a parasite found in tap water, swimming pools, hot tubs, and lakes that lead to a severe corneal ulcer.
Contact users must maintain good hygiene to prevent corneal ulcers and reduce their risk of an infection. This includes washing your hands regularly before handling contacts, disinfecting and disposing of lenses in a timely fashion, and frequent cleaning of contact lens cases. Individuals should also avoid wearing lenses during swimming or showering.
Patients with severe dry eyes, eyelid abnormalities leading to exposure of the cornea, and autoimmune disorders, such as rheumatoid arthritis, are especially prone to infection and should be aware of this possibility.
Any individual experiencing symptoms of eye pain or foreign body sensation, blurred vision, eye discharge, or light sensitivity should seek urgent care from an eye care provider. Delay in attention and treatment can lead to vision loss and sometimes even blindness or loss of the eye. Those who wear contacts should immediately stop using their lenses.
When treating corneal ulcers, your ophthalmologist or optometrist will obtain a detailed history and examine the extent and location of the ulcer. He or she will initiate the frequent use of topical antibiotics, and in certain severe or unusual circumstances, obtain cultures to determine the specific bacteria causing the infection. You will be asked to return for a reassessment of the ulcer and its response to antibiotics every 1 to 3 days.
Most patients respond well to topical antibiotics with good visual prognosis. In severe cases where the central cornea is affected, treatment may be required for a duration of several weeks to months. Patients can also develop cataracts or glaucoma concurrently. Permanent vision loss may occur despite aggressive treatment due to irreversible scarring of the cornea. In these rare cases, a corneal transplant procedure and long visual rehabilitation may be necessary to restore the patient’s vision.
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