I have left eye redness (conjunctival injection) and photophobia, likely related to contact lens wear; what is the likely diagnosis and what should I do immediately?

Unilateral Eye Redness with Photophobia in Contact Lens Wearer: Immediate Management

Remove your contact lens immediately and seek urgent ophthalmology evaluation today—this presentation suggests possible infectious keratitis, which can rapidly progress to vision loss if untreated. 1

Immediate Actions You Must Take Now

• Stop wearing your contact lens immediately and do not reinsert it until cleared by an ophthalmologist 1
• Contact an ophthalmologist urgently today—the combination of redness, photophobia, and contact lens wear represents a high-risk scenario for bacterial keratitis 1, 2
• Do not self-treat with over-the-counter drops or delay evaluation, as infectious keratitis can cause permanent vision loss within 24-48 hours if untreated 1

Why This Is Urgent

The triad of conjunctival injection (redness), photophobia (light sensitivity), and contact lens wear creates significant concern for infectious keratitis, which is a true ocular emergency. 1, 3

Key risk factors present in your case:

• Contact lens wear increases risk of bacterial keratitis 5-fold compared to non-wearers, and even occasional overnight wear substantially elevates this risk 1
• Photophobia is a warning sign that distinguishes potentially vision-threatening conditions from benign conjunctivitis 3, 4
• Unilateral presentation makes infection more likely than bilateral allergic or viral causes 3

What the Ophthalmologist Will Assess

Your ophthalmologist needs to urgently evaluate for:

• Corneal involvement using fluorescein staining and slit-lamp examination to identify epithelial defects or stromal infiltrates 1, 2
• Visual acuity—any vision worse than 20/40 mandates aggressive treatment 2
• Presence of corneal ulceration or infiltrate—these findings confirm infectious keratitis requiring immediate empiric antibiotic therapy 1
• Anterior chamber inflammation—cell and flare suggest more severe disease 2

Expected Treatment if Infection Is Confirmed

If infectious keratitis is diagnosed, expect:

• Immediate empiric broad-spectrum topical antibiotics (typically fluoroquinolones like moxifloxacin or ciprofloxacin) before culture results return 1, 5
• Frequent dosing (every 30-60 minutes initially for severe cases) to achieve adequate corneal penetration 1
• Close follow-up (daily initially) to monitor response and adjust therapy based on clinical course 1
• Cultures may be obtained if there is a corneal infiltrate or ulcer to guide targeted antibiotic therapy 1

Critical Pitfalls to Avoid

Do not use topical corticosteroids before infection is ruled out—steroids can dramatically worsen infectious keratitis and mask progression while causing corneal perforation. 2, 6

Do not assume this is "just conjunctivitis" because you have photophobia—viral or bacterial conjunctivitis rarely causes significant light sensitivity, which suggests corneal or intraocular involvement. 3, 4

Do not delay seeking care thinking symptoms will improve on their own—bacterial keratitis progresses rapidly and early treatment is essential to prevent permanent scarring and vision loss. 1

Contact Lens Hygiene Review for Prevention

Once this acute episode resolves, review these critical practices to prevent recurrence:

• Never sleep in contact lenses unless specifically approved extended-wear lenses, and even then understand the 5-fold increased infection risk 1
• Remove lenses before any water exposure—showering, swimming, or hot tubs with lenses dramatically increases risk of Acanthamoeba and Pseudomonas keratitis 1
• Rub and rinse lenses with fresh disinfecting solution every time you remove them—never "top off" old solution 1
• Replace your lens case every 3 months as cases become colonized with bacteria over time 1
• Wash hands with soap and dry thoroughly before every lens handling 1

Bottom Line

Your symptoms warrant same-day ophthalmology evaluation—do not wait until tomorrow or assume this will resolve spontaneously. The combination of contact lens wear, unilateral redness, and photophobia creates high suspicion for infectious keratitis, which requires urgent diagnosis and treatment to preserve vision. 1, 2