COMMENTARY

Keratitis and Contact Lens Use

Jennifer Cope, MD, MPH

Disclosures

November 14, 2014

Editorial Collaboration

Medscape &

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Hello. I am Dr Jennifer Cope, an epidemiologist with the Waterborne Disease Prevention Branch at CDC. I am here today as part of the CDC Expert Commentary Series on Medscape.

Millions of people enjoy the benefits of contact lenses, allowing them to see well without having to wear glasses. However, contact lenses are medical devices and not without some risk for complications. Improper contact lens use can increase the risk for such eye infections as conjunctivitis and microbial keratitis.[1,2] Conjunctivitis is an inflammation of the eye membranes that can cause symptoms of eye discharge, redness, pain, photophobia, foreign body sensation, and visual changes. Although antibiotics are often used to treat conjunctivitis, it tends to be a self-limiting condition that rarely results in serious complications.

Microbial keratitis, on the other hand, is inflammation of the cornea that may be caused by a range of pathogens, including bacteria, fungi, amebae, and viruses. Keratitis may have many of the same symptoms as conjunctivitis, but eye pain may be more prominent. If left untreated, microbial keratitis can cause serious damage to the eye, resulting in vision loss. The treatment for microbial keratitis differs depending on the type of pathogen causing the infection. Consequently, microbial keratitis requires rapid diagnosis and treatment by an ophthalmologist.

Microbial keratitis has been linked to poor contact lens hygiene habits, such as infrequent contact lens case replacement, sleeping in contact lenses, and exposing contact lenses to water. If your patient has eye inflammation which persists despite appropriate treatment for conjunctivitis, he or she may have keratitis or another serious eye complication and should be immediately referred to an ophthalmologist.

Although poor contact lens hygiene is a known risk factor for microbial keratitis, the overall burden and epidemiology of microbial keratitis in the United States have not been well described. A team of epidemiologists from CDC estimated the incidence and cost of keratitis using national ambulatory-care and emergency department databases.[4] The analysis showed that an estimated 930,000 outpatient visits and 58,000 emergency department visits for microbial keratitis occur annually. Episodes of keratitis cost an estimated $175 million in direct healthcare expenditures, including $58 million in costs for Medicare patients and $12 million in costs for Medicaid patients. Office and outpatient clinic visits occupied more than 250,000 hours of clinician time annually.

Established, modifiable risk factors for microbial keratitis underscore that this serious and costly eye infection is largely preventable, and patient education on healthy contact lens wear and care is critical. In close partnership with eye health experts, CDC has developed healthy contact lens wear and care recommendations for use when talking to your patients about contact lens hygiene.

Most of these strategies are well known to healthcare professionals. To promote good habits and hygiene, encourage your patients to wash their hands thoroughly before touching their contact lenses, avoid sleeping in contact lenses unless otherwise directed, and keep water away from their contact lenses. Instruct patients on rubbing and rinsing their contact lenses each time they are removed, replacing contact lenses and storage cases regularly, and never reusing contact lens solution.

Encourage patients to schedule an annual eye care exam and to contact an eye care provider immediately if experiencing any pain, discomfort, redness, or blurred vision. Finally, remind your patients that all contact lenses—even decorative lenses—require a prescription and a professional fitting from an eye care provider. Visit CDC for information and materials that can help you communicate these contact lens wear and care recommendations to your patients.

Web Resources

CDC Healthy Contact Lens Wear and Care

CDC Contact Lens Wear and Care Recommendations

CDC Contact Lens Health Promotion Materials

Jennifer Cope, MD, MPH, is a medical epidemiologist and infectious disease physician with the Waterborne Disease Prevention Branch in the National Center for Emerging and Zoonotic Infectious Diseases. She oversees the free-living ameba program which supports clinical, epidemiologic, laboratory, and communication activities related to the free-living amebae (Naegleria, Balamuthia, Acanthamoeba, and Sappinia).

Dr Cope began her career at CDC in 2009 as an Epidemic Intelligence Service (EIS) officer assigned to the North Dakota Department of Health. She joined the Waterborne Disease Prevention Branch as a preventive medicine resident in 2011 and transitioned to her current role as medical epidemiologist in 2013.

Dr Cope obtained a BS in microbiology from Penn State University and received her medical degree from the University of Pittsburgh School of Medicine. She completed residency training in internal medicine at the Emory University Hospitals and Grady Memorial Hospital in Atlanta, and infectious disease fellowship training at the University of Maryland Medical Center in Baltimore. She is board certified in both internal medicine and infectious diseases.

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