• Users Online: 1536
  • Home
  • Print this page
  • Email this page

   Table of Contents      
BRIEF REPORT
Year : 2007  |  Volume : 55  |  Issue : 1  |  Page : 64-67

Ulcerative keratitis associated with contact lens wear


1 Microbiology Research Centre, Tirunelveli, Tamil Nadu - 627 001, India
2 Cornea Service, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli, Tamil Nadu - 627 001, India

Date of Submission03-Mar-2006
Date of Acceptance02-Sep-2006

Correspondence Address:
M Jayahar Bharathi
Microbiology Research Centre, Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Tirunelveli - 627 001
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0301-4738.29500

Rights and Permissions
  Abstract 

To review the microbiological profile of ulcerative keratitis associated with contact lens (CL)-wear, 35 patients with culture-proven CL-associated microbial keratitis were studied between September 1999 and September 2002. Corneal scrapes and CL-care products were collected and were subjected to microbiological evaluation. Gram-negative bacilli alone were recovered from the corneal scrapes of all 35 (100%) patients, all 70 (100%) CL storage case wells and also from CL-care solution of six (17.14%) of the 35 patients. There was a significantly higher number of Pseudomonas aeruginosa (71.43%) isolated from eyes with CL-related keratitis than other bacterial isolates (28.57%) ( P <0.001). Microbial contamination of CL storage cases was a great risk for gram-negative bacterial infection among soft CL-wearers.

Keywords: Contact lens-associated keratitis, incidence, microbial etiology, microbial contamination of contact lens-care system, P. aeruginosa .


How to cite this article:
Bharathi M J, Ramakrishnan R, Meenakshi R, Kumar C S, Padmavathy S, Mittal S. Ulcerative keratitis associated with contact lens wear. Indian J Ophthalmol 2007;55:64-7

How to cite this URL:
Bharathi M J, Ramakrishnan R, Meenakshi R, Kumar C S, Padmavathy S, Mittal S. Ulcerative keratitis associated with contact lens wear. Indian J Ophthalmol [serial online] 2007 [cited 2022 May 18];55:64-7. Available from: https://www.ijo.in/text.asp?2007/55/1/64/29500

Microorganisms isolated from corneal scrapes, contact lens cassette wells and contact lens care solutions of 35
patients with contact lens-associated microbial keratitis


Click here to view
Microorganisms isolated from corneal scrapes, contact lens cassette wells and contact lens care solutions of 35
patients with contact lens-associated microbial keratitis


Click here to view
Clinical and microbiological profiles of the 35 patients (38 infected eyes) with contact lens associated microbial keratitis in South India

Click here to view
Clinical and microbiological profiles of the 35 patients (38 infected eyes) with contact lens associated microbial keratitis in South India

Click here to view
Microbial keratitis is a potentially vision-threatening condition and it leads to significant public health problem.[1] Although nonsurgical trauma to the eye accounted for 48.6-65.4% of all corneal ulcers in the developing countries of Nepal[2] and India,[3] in the United States, it accounted for only 27% of corneal ulcers.[4] In the developed nations it is contact lens (CL) wear that has emerged as a major risk factor for microbial keratitis.[1] The purpose of this study was to determine the current trends in the incidence and the microbiological profile of CL-induced microbial keratitis.


  Materials and Methods Top


All culture-positive cases of CL-associated microbial keratitis presenting between September 1999 to September 2002 were included in this retrospective study. Each patient was examined at the slit-lamp; clinical features were noted and drawing was made for patient's records. A corneal scrape was performed using flame-sterilized Kimura spatula or Bard-Parker blade (# 15) following instillation of 0.5% proparacaine hydrochloride. The material obtained was subjected to direct microscopic examinations (10% potassium hydroxide wet mount and Gram-stain) and culture (on 7% sheep blood agar, chocolate agar, Sabouraud dextrose agar, nonnutrient agar, thioglycollate medium and brain heart infusion broth media). In addition to corneal scrapes, CL storage cases along with lenses and lens care solution bottles were collected at the time of presentation and were subjected to microbiological evaluation for determining the microbial contamination of lens care product. A standardized protocol was followed for each patient with corneal ulceration for the evaluation of microbiological and clinical features.[5] Pearson's Chi-square test was used to carry out the statistical analysis wherever required and P value < 0.05 considered to be statistically significant.


  Results Top


A total of 3295 consecutive patients with corneal ulceration were evaluated, of which, corneal ulcers associated with the use of CLs were identified in 35 patients (1.06% of 3295). All 35 patients wore soft CLs for their refractive error corrections under the daily wearing schedule. The patients ranged in age from 14 to 28 years (mean; 20.8 years, SD 3.65) [Table - 1]. Females (74.29%) predominated males and the majority of them were students (82.86%). Of 35 patients, single eye was infected in 32(91.43%) patients and both eyes were affected in three (8.57%) patients. Total of 38 eyes were studied [Table - 1].

A total of 42 bacterial pathogens were recovered from 38 ulcerative cornea, of which 30(71.43%) were Pseudomonas aeruginosa (28 were isolated as single species and the remaining two were mixed with Enterobacter sp.) . The culture of CL storage cases (total of 70 wells) and the lens care solution of 35 patients yielded positive bacterial growth in all 70 wells and six of the 35 bottles of lens care solution respectively. Bacterial pathogens recovered from CL storage cases were identical with the bacterial species recovered from the corneal scrapes of the respective infected eyes [Table - 1][Table - 2].


  Discussion Top


With growth of soft CL wear, the incidence of CL-associated microbial keratitis has increased to up to 30% of all keratitis in developed countries,[1] , [6] whereas in this present study, it was found to be 1%. This low incidence in the present study may be attributed to the limited number of people wearing CL in our region due to economic factor. The microbes responsible for CL-associated keratitis include gram-negative bacteria and rarely, gram-positive bacteria and fungi, whereas Acanthamoeba predominated in the developed countries.[1] Several CL-related and non-CL-related factors were attributed to the higher incidence of Acanthamoeba keratitis among CL wearers in developed nations.[7] In contrast, bacteria was found to be the only pathogen for all CL-associated keratitis in this study. Pseudomonas aeruginosa was reported to be the most common organism isolated from CL wearers in the developing world[8] and similarly P. aeruginosa ( P <0.001, odds ratio: 11.54, 95% CI: 5.81-22.92) is more frequent than other gram-negative bacilli in this study.

All CL storage cases and six lens care solution bottles were found to be contaminated with potential gram-negative bacilli in this study and the bacterial pathogens recovered from the corneal scrapes were identical with the bacterial pathogens isolated from the CL storage case wells of corresponding infected eyes. It can be assumed that the source of contamination was the CL storage cases. In developing countries like India, commonly used water is contaminated by gut commensals, especially Pseudomonas. Contact of CLs and CL storage cases with water can cause contamination by Pseudomonas , which survives well in the moist environment offered by CLs, CL storage cases and lens care solutions. Contaminated CLs which were used by the patients, acted as a vector for transmitting the microbes from the CL storage cases to the patients' conjunctiva and cornea by forming polysaccharide-containing bio-film on the posterior surface of soft CLs by bacterial adherence. Bacterial adherence to artificial surface is also thought to be mediated by hydrophobic bonding and relatively hydrophobic strains adhere very readily to CLs. In addition, more acidic environment due to raised level of lactic acid and carbonic acid in the tear film could reduce the pH and increase bacterial adhesion.[9] Although Pseudomonas adhere poorly to intact corneal epithelium, corneal surface damage due to trauma by poorly maintained CLs during the insertion and removal of CLs provide entry into the cornea leading to keratitis by Pseudomonas .

The type of microorganisms recovered from the corneal scrapes and CL-care products- P. aeruginosa , Enterobacter sp, Klebsiella sp, Alcaligens sp. and Serratia sp, are not part of the resident ocular flora and are widely distributed in soil, water, sewage, gastrointestinal tract of humans and their presence indicates that the source of contamination is external in nature.[10] In conclusion, the incidence of CL-induced microbial keratitis is lower (1%) than the incidence due to other risk factors in our region. Undoubtedly the microbial contamination of CL storage cases was a great risk for gram-negative corneal infection among soft CL-wearers. Pseudomonas spp. were the dominant causative agents. Increased awareness of adequate lens care and disinfection practices, continuous supervision of all CL-wearers and frequent replacement of CL storage cases would greatly help to reduce this risk of infection on cornea.

 
  References Top

1.
Whitcher JP, Srinivasan M, Upadhyay MP. Microbial keratitis. In : Johnson GJ, Minassian DC, Weale RA, West SK, editors. The Epidemiology of Eye Dieases . 2nd ed. Arnold: London; 2003. p. 190-5.   Back to cited text no. 1
    
2.
Upadhyay MP, Karmacharya PC, Koirala S, Shah DN, Shakya S, Shrestha JK, et al . The Bhaktapur eye study: Ocular trauma and antibiotic prophylaxis for the prevention of corneal ulceration in Nepal. Br J Ophthalmol 2001;85:388-92.  Back to cited text no. 2
    
3.
Srinivasan M, Gonzales CA, George C, Cevallos V, Mascarenhas JM, Asokan B, et al. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, South India. Br J Ophthalmol 1997;81:965-71.  Back to cited text no. 3
    
4.
Ormerod LD, Hertzmark E, Gomez DS, Stabiner RG, Schanzlin DJ, Smith RE. Epidemiology of microbial keratitis in southern California: A multivariate analysis. Ophthalmology 1987;94: 1322-23.  Back to cited text no. 4
[PUBMED]    
5.
Jones DB, Liesegang TJ, Robinson NM. Laboratory diagnosis of ocular infections . American Society for Microbiology: Washington DC; 1981.   Back to cited text no. 5
    
6.
Mah-Sadorra JH, Yavuz SG, Najjar DM, Laibson PR, Rapuano CJ, Cohen EJ. Trends in contact lens-related corneal ulcers. Cornea 2005;24:51-8.   Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.
Illingworth CD, Cook SD. Acanthamoeba keratitis. Surv Ophthalmol 1998;42:493-508.   Back to cited text no. 7
[PUBMED]  [FULLTEXT]  
8.
Sharma S, Gopalakrishnan S, Aasuri A, Garg P, Rao GN. Trends in contact lens-associated microbial keratitis in southern India. Ophthalmology 2003;110:138-43.   Back to cited text no. 8
    
9.
Raskin EM, Speaker MG, McCormick SA, Wong D, Menikoff JA, Pelton-Henrion K. Influence of haptic materials on the adherence of Staphylococci to intraocular lenses. Arch Ophthalmol 1993;111:250-3.  Back to cited text no. 9
[PUBMED]    
10.
Sankaridurg PR, Vuppala N, Sreedharan A, Vadlamudi J, Rao GN. Gram-negative bacteria and contact lens induced acute red eye. Indian J Ophthalmol 1996;44:29-32.  Back to cited text no. 10
[PUBMED]  [FULLTEXT]  



 
 
    Tables

  [Table - 1], [Table - 2]


This article has been cited by
1 Bacterial isolates and their biofilm formation on contact lenses
Deborah Purushottam M, Nesepogu Padmaja
IP International Journal of Medical Microbiology and Tropical Diseases. 2022; 8(1): 10
[Pubmed] | [DOI]
2 A case of double hypopyon secondary to Serratia keratitis after penetrating keratoplasty
Ajit Kumar, Ashi Khurana, Mohit Sharma
Indian Journal of Ophthalmology - Case Reports. 2022; 2(1): 39
[Pubmed] | [DOI]
3 Understanding clinical and immunological features associated with Pseudomonas and Staphylococcus keratitis
Gauri Shankar Shrestha, Ajay Kumar Vijay, Fiona Stapleton, Fiona L. Henriquez, Nicole Carnt
Contact Lens and Anterior Eye. 2021; 44(1): 3
[Pubmed] | [DOI]
4 Prevalence and antibacterial resistance patterns of extended-spectrum beta-lactamase producing Gram-negative bacteria isolated from ocular infections
G Rameshkumar, R Ramakrishnan, C Shivkumar, R Meenakshi, V Anitha, YC Venugopal Reddy, V Maneksha
Indian Journal of Ophthalmology. 2016; 64(4): 303
[Pubmed] | [DOI]
5 Clinical and microbiological characteristics of corneal ulcers in a Thai referral center
Kosol Kampitak, Haruetai Suntisetsin, Tasanee Sirikul
Asian Biomedicine. 2014; 8(2): 275
[Pubmed] | [DOI]
6 Analysis of Inpatients with Contact Lens Related Bacterial Keratitis: Causative Microorganisms, Clinical Aspects, and Prognostic Factors
Chan Ho Cho,Sang-Bumm Lee
Journal of the Korean Ophthalmological Society. 2013; 54(9): 1327
[Pubmed] | [DOI]
7 Microbial contamination of contact lens storage cases and domestic tap water of contact lens wearers
Miray Üstüntürk,Zuhal Zeybek
Wiener klinische Wochenschrift. 2012; 124(S3): 17
[Pubmed] | [DOI]
8 Patient attitudes and behavior regarding hygiene and replacement of soft contact lenses and storage cases
Sheila Hickson-Curran, Robin L. Chalmers, Colleen Riley
Contact Lens and Anterior Eye. 2011; 34(5): 207
[VIEW] | [DOI]
9 Prevention of seroma formation after axillary dissection in breast cancer: A systematic review
A.J.M. van Bemmel, C.J.H. van de Velde, R.F. Schmitz, G.J. Liefers
European Journal of Surgical Oncology (EJSO). 2011; 37(10): 829
[VIEW] | [DOI]
10 Comparison of Besifloxacin, Gatifloxacin, and Moxifloxacin Against Strains of Pseudomonas aeruginosa With Different Quinolone Susceptibility Patterns in a Rabbit Model of Keratitis :
Melissa E Sanders, Quincy C Moore, Erin W Norcross, Christine M Sanfilippo, Christine K Hesje, Afshin Shafiee, Mary E Marquart
Cornea. 2011; 30(1): 83
[VIEW] | [DOI]
11 Defensins in innate immunity
Linda Hazlett, Minhao Wu
Cell and Tissue Research. 2011; 343(1): 175
[VIEW] | [DOI]
12 Activation of ExoU Phospholipase Activity Requires Specific C-Terminal Regions
Katherine M. Schmalzer, Marc A. Benson, Dara W. Frank
Journal of Bacteriology. 2010; 192(7): 1801
[Pubmed] | [DOI]
13 Activation of ExoU phospholipase activity requires specific C-terminal regions
Schmalzer, K.M., Benson, M.A., Frank, D.W.
Journal of Bacteriology. 2010; 192(7): 1801-1812
[Pubmed]
14 Non-compliance and microbial contamination in orthokeratology
Cho, P., Boost, M., Cheng, R.
Optometry and Vision Science. 2009; 86(11): 1227-1234
[Pubmed]
15 Microbial keratitis in Kingdom of Bahrain: Clinical and microbiology study
Al-Yousuf, N.
Middle East African Journal of Ophthalmology. 2009; 16(1): 3
[Pubmed]
16 Predisposing factors, clinical and microbiological aspects of bacterial keratitis: A clinical study
Cruciani, F., Cuozzo, G., Di Pillo, S., Cavallaro, M.
Clinica Terapeutica. 2009; 160(3): 207-210
[Pubmed]
17 Non-Compliance and Microbial Contamination in Orthokeratology
Pauline Cho,Maureen Boost,Roy Cheng
Optometry and Vision Science. 2009; 86(11): 1227
[Pubmed] | [DOI]
18 Clinical risks: Myths and truths - Interpreting the evidence-based data about contact lens care
Levy, B., Orsborn, G.
Clinical and Refractive Optometry. 2008; 19(6): 165-171
[Pubmed]
19 Mutation of the phospholipase catalytic domain of the Pseudomonas aeruginosa cytotoxin ExoU abolishes colonization promoting activity and reduces corneal disease severity
Tam, C., Lewis, S.E., Li, W.Y., Lee, E., Evans, D.J., Fleiszig, S.M.J.
Experimental Eye Research. 2007; 85(6): 799-805
[Pubmed]
20 Letter to the editor
Pachigolla, G., Blomquist, P.H., Cavanagh, H.D.
Eye and Contact Lens. 2007; 33(4): 207
[Pubmed]
21 Infective keratitis: A challenge to Indian ophthalmologists
Srinivasan, M.
Indian Journal of Ophthalmology. 2007; 55(1): 5-6
[Pubmed]
22 Mutation of the phospholipase catalytic domain of the Pseudomonas aeruginosa cytotoxin ExoU abolishes colonization promoting activity and reduces corneal disease severity
C. Tam,S.E. Lewis,W.Y. Li,E. Lee,D.J. Evans,S.M.J. Fleiszig
Experimental Eye Research. 2007; 85(6): 799
[Pubmed] | [DOI]
23 Letter to the Editor
Gowri Pachigolla,Preston H. Blomquist,H Dwight Cavanagh
Eye & Contact Lens: Science & Clinical Practice. 2007; 33(4): 207
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Materials and Me...
Results
Discussion
References
Article Tables

 Article Access Statistics
    Viewed6565    
    Printed150    
    Emailed7    
    PDF Downloaded636    
    Comments [Add]    
    Cited by others 23    

Recommend this journal