Clinical Management of Infectious Contact Lens Complications: From Antibiotics to Quorum-sensing Inhibitors

Alexander A Bialasiewicz; Katharina A Breidenbach; Volker Klauss; Rashid M Al-Saeidi; Radha Shenoy; Gudrun Bischoff


Expert Rev Ophthalmol. 2010;5(6):789-797. 

In This Article

Abstract and Introduction


Although effective drugs have become available, improvements in the treatment of contact lens-associated microbial keratitis are required. Over the last decade, the outcome of contact lens-associated bacterial keratitis has improved owing to fluoroquinolones, leading to a better control of infection, earlier institution of anti-inflammatory therapy and surgical intervention. The antimicrobial effectiveness of some antibiotics may be increased by preservatives. Antibiotic resistance according to serum standard limits has not been found to be relevant for the eye, with the exception of methicillin-resistant Staphylococcus aureus. Newer antifungals (voriconazole, itraconazole) are being evaluated, but the mainstay is liposomal amphotericin B and econzole or natamycin. Therapy for acanthamebic (biguanides and combinations) and microsporidial (fluoroquinolones) infections remains unchanged. New hydrophilic contact lens materials may slow down the formation of biofilm. Antibiofilm research has introduced substances that interfere with quorum sensing, and affect enzymatic and peptide-mediated matrix dispersal. Nanotechnology will be used to penetrate the biofilm matrix as well as nanoetching to prevent biofilm development on surfaces. Management of contact lens keratitis comprises of management of the biofilm. Early aggressive antimicrobial treatment, and surgery in certain cases, have resulted in better outcomes. The role of corticosteroids seems beneficial, but has to be further studied. Further improvements rely on biofilm-active agents added to antimicrobials.


Effective antimicrobials have fuelled an impressive improvement in the outcomes of infectious contact lens (CL) complications over the last 20 years. The reasons for the development of these infections – neglect of hygiene regimens and inappropriate storage and solutions – have been recognized but not challenged.[1] Fluoroquinolones combined in an individualized fashion with anti-inflammatory and surgical therapy have significantly improved the outcomes of CL-induced bacterial infections. Anecdotal reports on the application of newer antifungals are forecasting progress in the treatment of CL-associated fungal keratitis.

In this article, we focus on the current management of primarily bacterial infectious keratitis, as well as on some relevant revolutionary biofilm research, which is expected to improve outcomes over the next 5 years.


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