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Case Reports of Three Atypical Infiltrative Keratitis Events With High DK Soft Contact Lens Wear

Skotnitsky, Cheryl O.D.; Jalbert, Isabelle O.D., F.A.A.O.; O'Hare, Nicole B.Optom.; Sweeney, Deborah F. Ph.D., F.A.A.O.; Holden, Brien A. Ph.D., D.Sc., F.A.A.O.

Case Reports

Purpose. We report three atypical infiltrative keratitis events in patients that had successfully worn highly oxygen permeable (Dk) soft contact lenses on an extended wear (EW) schedule for at least 15 months. These cases highlight the role of patient/practitioner education, patient compliance, examination, and appropriate referrals that are required to reduce the risk of complications during lens wear.

Methods and Results. Each patient had been wearing high Dk soft lenses on an EW schedule with monthly replacement for at least 15 months and presented with severe pain, redness, and photophobia. The events were characterized by focal infiltrate(s) with an overlying epithelial defect in the superior periphery to mid-periphery of the cornea and extensive diffuse infiltration.

Conclusions. The signs and symptoms of each case were more severe than is typically associated with contact lens–related infiltrative keratitis. Because of the slow progression of signs and relatively fast resolution, the cases were not found to be microbial keratitis. Although high Dk soft contact lenses overcome hypoxia-associated complications associated with extended wear, patients and practitioners must be vigilant as adverse events can still occur and in rare instances can be severe. Education and patient compliance are a crucial part of successful management of patients on EW schedules. Constant reinforcement is necessary to ensure patient compliance.

From the Cooperative Research Center for Eye Research and Technology and the Contact Lens Research Unit, School of Optometry, The University of New South Wales, Sydney, Australia.

Submitted July 16, 2001.

Revision received December 19, 2001.

Accepted December 21, 2001.

These case reports were from patients in studies funded by the Australian Federal Government through the Cooperative Research Centers scheme in part by CIBA Vision.

Address correspondence and reprint requests to Dr. D.F. Sweeney, Cooperative Research Centre for Eye Research & Technology, University of New South Wales, UNSW Sydney, Sydney 2052 Australia. E-mail:

© 2002 Lippincott Williams & Wilkins, Inc.