Managing Keratitis in Contact Lens Wearers

Consider these steps when managing keratitis in contact lens wearers, noted Josh K. Johnston, OD, Clinical Director at Georgia Eye Partners in Atlanta, during the American Optometric Association’s 2018 annual meeting in Denver: 

• For broad spectrum initial coverage, use moxifloxacin, besifloxacin, or gatifloxacin every 1 to 2 hours while awake.
• For advanced coverage, use fortified vancomycin (25 mg/mL) + fortified tobramycin (14 mg/mL), along with a fluoroquinolone.
• Culture when appropriate, using agents customized to the organism.
• Use specialized agents for acanthamoeba.
• Watch for resistance, including MRSA; consider polytrim or fortified vancomycin. 
• Pseudomonas can be resistant to fluoroquinolones; consider double-coverage if necessary. 
• Use antibiotics for corneal abrasions to prevent ulceration.
• Consider bandage contact lenses for abrasions, as long as patient is monitored closely and receives antibiotics. 
• Do not patch abrasions in contact lens wearers; be cautious patching any abrasion.

Johnston J. Red eyes: It’s just conjunctivitis…Or is it? Talk presented at: 2018 AOA Annual Meeting; June 20-24, Denver. http://www.optometrysmeeting.org/documents/handouts/2018/0100.pdf