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Central Toxic Keratopathy After Contact Lens Wear and Mechanical Debridement

Clinical Characteristics, and Visual and Corneal Tomographic Outcomes

Ting, Darren Shu Jeng F.R.C.Ophth.; Ghosh, Saurabh F.R.C.Ophth.

doi: 10.1097/ICL.0000000000000575
Case Report

Objectives: To highlight the clinical characteristics, and visual and corneal tomographic outcomes of central toxic keratopathy (CTK) after contact lens (CL) wear and mechanical debridement.

Methods: A retrospective observational case series with literature review.

Results: Four patients (4 eyes) were included in this study; 3 (75%) females, mean age 29.3±8.1 years. The mean follow-up was 13.5±7.5 months. Early central or paracentral stromal opacification, assuming an inverse dome-shaped pattern observed under anterior-segment optical coherence tomography, with corneal flattening (Kmean 40.4±1.3 D) and thinning (mean thinnest pachymetry=404.8±29.4 microns) were observed in all cases. All patients had a recent use of CL wear, with three after mechanical debridement for recurrent corneal erosion syndrome. None of them had any previous laser refractive surgery (LRS). The mean corrected distance visual acuity improved from 20/40 (ranged 20/25–20/50) initially to 20/30 (ranged 20/20–20/40) at final follow-up, and the outcome was not influenced by the use of topical steroids. A mean improvement of corneal flattening (+Kmean 1.2±1.2 D), thinning (+123.5±23.8 microns), and astigmatism (−3.0±2.7 D), via epithelial and stromal remodeling, was observed up to 15 months after CTK. Persisting reduced corneal sensation was noted in all patients at the final follow-up.

Conclusions: Central toxic keratopathy is not an exclusive complication of LRS, and it may occur after CL wear and mechanical debridement. Our findings are similar to those of LRS-related CTK and toxic peripheral keratopathy. Awareness of the clinical associations and understanding of the clinical course and tomographic characteristics of CTK helps obviate unnecessary investigation and overtreatment. Further studies are required to elucidate the underlying pathogenesis of this rare clinical entity.

Sunderland Eye Infirmary (D.S.J.T., S.G.), Queen Alexandra Road, Sunderland, United Kingdom; and Academic Ophthalmology (D.S.J.T.), Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, United Kingdom.

Address correspondence to Darren Shu Jeng Ting, F.R.C.Ophth, Academic Ophthalmology, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham NG7 2RD, United Kindom; e-mail:

The authors have no funding or conflicts of interest to disclose.

Accepted December 16, 2018

© 2019 Contact Lens Association of Ophthalmologists, Inc.