Correspondence

Corneal Ulcers from Contact Lenses during Travel to Remote Areas

N Engl J Med 1998; 338:1629-1630May 28, 1998

Article

To the Editor:

Travelers to remote destinations may not have access to immediate medical care in case of an emergency. Contact-lens wearers, in particular, should take precautions, since they are susceptible to serious microbial keratitis.1-4 We describe two patients in whom corneal ulcers developed while they were vacationing in remote areas.

A corneal ulcer developed in a 57-year-old woman while she was vacationing in Tahiti. The woman used daily-wear soft contact lenses and removed her lenses before going to bed. She went to a local physician and was treated with intravenous gentamicin; an ophthalmologist was not available. Her condition did not improve, and she flew back to the United States three days later. She underwent ophthalmic evaluation and was treated with topical fortified tobramycin and cefazolin eye drops. Her corneal ulcer healed, with central scarring. She later required corneal transplantation to restore her vision. Pretreatment corneal cultures grew Pseudomonas aeruginosa.

A 64-year-old woman on safari in Tanzania wore disposable soft contact lenses. She wore a new pair of lenses each day and removed them before going to bed. On the fifth day of the safari, she awoke with pain and loss of vision in her right eye. An ophthalmologist who was traveling with her group examined her. Visual acuity was based on a finger count. Examination with a magnifying glass revealed a central corneal infiltrate. A diagnosis of bacterial corneal ulcer was made, and the patient began using ciprofloxacin (Ciloxan) eye drops every hour. Six days later, she traveled to London, where an ophthalmic examination revealed a best corrected visual acuity of 20/25 in the affected eye and a faint paracentral corneal scar.

Bacterial corneal ulcers are a serious and often devastating complication of contact-lens use.1-4 Discontinuation of contact-lens use along with early treatment is essential to preserve vision, especially in cases of infection caused by P. aeruginosa. 1-4 Unfortunately, early ophthalmic care may not be available in remote locations. In the case of the second patient, had an ophthalmologist not been traveling with her, she would have had to wait at least an additional day for an ophthalmic evaluation. Fortunately, immediate therapy led to a complete cure.

Both patients had been given a host of emergency medications by their physicians before going on vacation, but the only ocular medications included were lubricants. As these case reports demonstrate, immediate treatment and the use of topical antibiotics can preserve vision; this fact justifies the inclusion of such topical antibiotics in an emergency medical kit. Especially if they travel to remote regions, contact-lens wearers should be educated about the management of contact-lens–related problems.

Paul B. Donzis, M.D.
UCLA School of Medicine, Los Angeles, CA 90024

4 References

1. 1

   Weissman BA, Mondino BJ, Pettit TH, Hofbauer JD. Corneal ulcers associated with extended-wear contact lenses. Am J Ophthalmol 1984;97:476-481
   Web of Science | Medline

2. 2

   Mondino BJ, Weissman BA, Farb MD, Pettit TH. Corneal ulcers associated with daily-wear and extended-wear contact lenses. Am J Ophthalmol 1986;102:58-65
   Web of Science | Medline

3. 3

   Weissman BA, Donzis PB, Hoft RH. Keratitis and contact lens wear: a review. J Am Optom Assoc 1987;58:799-803
   Medline

4. 4

   Dunn JP Jr, Mondino BJ, Weissman BA, Donzis PB, Kikkawa DO. Corneal ulcers associated with disposable hydrogel contact lenses. Am J Ophthalmol 1989;108:113-117
   Web of Science | Medline

Citing Articles (1)

Citing Articles

1. 1

   Barry A. Weissman, Bartly J. Mondino. (2002) Risk factors for contact lens associated microbial keratitis. Contact Lens and Anterior Eye 25:1, 3-9
   CrossRef