What is the treatment for a contact lens-related eye infection?

Treatment for Contact Lens-Related Eye Infections

For contact lens-related eye infections, immediately discontinue contact lens wear and treat with fluoroquinolone antibiotics such as moxifloxacin 0.5% eye drops three times daily for 7 days. 1, 2

Immediate Management

• Remove contact lenses immediately and do not reuse until infection completely resolves 1
• Discontinue all contact lens wear until the cornea returns to normal 3
• Discard current contact lenses and case to prevent reinfection 1

Antibiotic Treatment Options

First-line Treatment

• Fluoroquinolone eye drops (broad-spectrum coverage against common pathogens including Pseudomonas aeruginosa) 1, 4
  • Moxifloxacin 0.5% - 1 drop 3 times daily for 7 days 2
  • Gatifloxacin 0.3% - 1 drop 3 times daily for 7 days 1
  • Ciprofloxacin 0.3% - 1 drop 3 times daily for 7 days 1, 4

For Severe Infections (Bacterial Keratitis)

• Fortified antibiotics may be necessary 3, 1
  • Fortified tobramycin (14 mg/ml) 3, 1
  • Fortified cefazolin or ceftazidime (50 mg/ml) 3

Adjunctive Treatments

• For mild cases: Brief course (1-2 weeks) of topical corticosteroids may be prescribed after infection is controlled 3, 1
• Consider topical cyclosporine 0.05% for longer-term use in cases with significant inflammation 3
• In resistant cases: Povidone-iodine 0.66% can be added to antibiotic treatment to broaden antimicrobial spectrum 5

Follow-Up Care

• If no improvement after 48-72 hours, consider:
  • Culture and sensitivity testing 1
  • Evaluation for bacterial keratitis 1
  • Modification of antibiotic therapy based on clinical response 1
• Return visit in 3-4 days if no improvement is seen 1

Prevention of Future Infections

After resolution of the infection:

• Consider switching to daily disposable contact lenses 1
• Review and modify contact lens care practices:
  • Never use tap water with contact lenses 3, 1
  • Replace lens case every 3 months 3, 1
  • Never "top off" old solution with new solution 3, 1
  • Avoid overnight wear (increases infection risk 5-fold) 3, 1

Common Pitfalls and Caveats

• Acanthamoeba keratitis should be suspected if moderate to severe pain is present, especially with history of swimming or showering while wearing lenses 3, 6
• Pseudomonas aeruginosa is the most common cause of contact lens-related bacterial keratitis and requires aggressive treatment 4, 7
• Avoid delaying treatment while waiting for culture results in severe cases 1
• Consider alternatives to contact lenses (eyeglasses or refractive surgery) if recurrent infections occur 3

Early and appropriate treatment of contact lens-related eye infections is crucial to prevent complications such as corneal scarring, perforation, or vision loss 4, 8.