BACKGROUND: The case report relates to a contact lens wearing patient referred with painful, photophobic red eye to Croydon Eye Hospital casualty by a local optometrist. The report describes a case of pseudomonas aeriginosa ulcer with 30 day continuous wear silicone hydrogel, highlighting contributory factors to the severity of the event that lead to vision loss and permanent scarring.

CASE REPORT(S): The patient, a 26-year-old female, had successfully worn Easy Vision All Day All Night (Lotrafilcon A) contact lenses for 3 years, changing her contact lenses monthly, and wearing them without removal on average of 30 days. She presented to her contact lens practitioner at midday complaining of pain, itchiness, redness, and light sensitivity. After examination, she was instructed not to wear contact lenses and was sent home. The following day the patient consulted an optometrist local to her home with increased lacrimation, redness and pain and was immediately referred. She was diagnosed to have microbial keratitis and corneal scrapping isolated pseudomonas aeruginosa. Aggressive treatment was immediate (Ofloxacin hourly, Gentamicin hourly) and included hospitalization. Examination one month post-event included LogMAR visual acuity, videokeratoscopy, videoaberroscopy, slit lamp photography, confocal microscopy. It revealed permanent VA loss, increased corneal aberrations, multiple deep corneal scarring within the pupillary area and endothelial cell loss.

CONCLUSIONS: The poster will describe in details this case history that confirms that despite full respect of the cornea oxygen physiological needs, silicone hydrogel can produce mechanical corneal damage that facilitates bacterial penetration and infection. The case highlights the need for rapid and correct diagnosis and the very grave consequences of delay in treatment.