Treatment for Bacterial Conjunctivitis in Contact Lens Wearers
For patients with bacterial conjunctivitis who wear contact lenses, immediate discontinuation of contact lens wear is required, followed by treatment with topical fluoroquinolones such as moxifloxacin or gatifloxacin until complete resolution of symptoms. 1, 2
Initial Management
- Immediately remove contact lenses and discontinue wear until the cornea completely returns to normal 1
- Rule out more serious conditions like contact lens-related keratoconjunctivitis or Acanthamoeba keratitis, especially if moderate to severe pain is present 1
- Advise patients not to wear contact lenses during the entire treatment period and until complete resolution of symptoms 3, 4
Antibiotic Treatment
- Fluoroquinolones (moxifloxacin, gatifloxacin) are the preferred first-line treatment due to their broad-spectrum coverage against common pathogens in contact lens wearers 5, 6
- For the first 2 days, apply antibiotic drops in the affected eye(s) twice daily, then once daily for the next 5 days 3
- Complete the full course of antibiotic therapy even if symptoms improve early to prevent bacterial resistance 3
- Azithromycin ophthalmic solution is an alternative with a similar dosing regimen (twice daily for 2 days, then once daily for 5 days) 3
Important Precautions
- Warn patients that skipping doses or not completing the full course may decrease treatment effectiveness and increase bacterial resistance 3
- Avoid using topical steroids initially as they may delay healing and increase infection risk 7
- Avoid eye patching in contact lens wearers as it may increase the risk of bacterial keratitis 7
- Monitor for warning signs requiring immediate care: increasing pain, purulent discharge, corneal infiltrate, or vision loss 7, 8
Follow-up Care
- Review the contact lens fit, type, and care regimen before resuming contact lens wear 1
- Consider recommending daily disposable contact lenses or hydrogen peroxide cleaning systems to reduce future infection risk 2
- Educate patients on proper contact lens hygiene:
- Never rinse lenses or cases with tap water, bottled water, or homemade saline 2
- Clean and replace contact lens cases at least every 3 months 2
- Use only fresh contact lens disinfecting solution and never mix old and new solutions 2
- Avoid overnight wear of contact lenses, which increases infection risk fivefold 2
- Avoid wearing contact lenses while swimming, in hot tubs, showering, or bathing 2
Common Pitfalls to Avoid
- Failing to discontinue contact lens wear during treatment can lead to prolonged infection and complications 1
- Resuming contact lens wear too early before complete resolution can lead to recurrence and chronic issues 1
- Using preserved solutions in patients with solution sensitivity can exacerbate inflammation 1
- Pseudomonas aeruginosa is the most common causative organism in contact lens-related bacterial keratitis and requires appropriate antibiotic coverage 6