Concluded Case

Contact Lens induced Sterile Keratitis

Contact Lens users... Blur vision.. Pain and redness Stain negative, stromal infiltrate Diagnosis ?

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Contact related keratitis presenting mild to moderate conjunctival injection ,& focal infiltrate round white fund or oval infiltrate devoid of epithelial defect with punctuate erosions due to staphylococcus aureus bacterial toxins and immunological agents enter through erosions leading to infiltrate , May also occur due to contact lens hypoxia Management discontinue contact lens use

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Contact related keratitis presenting mild to moderate conjunctival injection ,& focal infiltrate round white fund or oval infiltrate devoid of epithelial defect with punctuate erosions due to staphylococcus aureus bacterial toxins and immunological agents enter through erosions leading to infiltrate , May also occur due to contact lens hypoxia Management discontinue contact lens use

Most likely an acanthamoeba keratitis I wish treatment by atropine and agent like 0.1 per cent +0.02 per cent polyhexamethylene biguanide may be tried and never by steroids (because they predispose to this parasitic affection ).

Thank you Sir
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Any infiltration in cornea of contact lens wearer must be treated as of infective origin . This must be treated in line of corneal ulcer. I would like to know the findings suggestive of sterile nature of infiltration in thi particular pt.

Acanthamoebic keratitis Different regimens include combinations of diamidines, biguanides, antibiotics and antifungals. Some topical preparations of diamidines are propamidine-isethionate, hexamidine-diisethionate, and dibromopropamidine. Biguanides include polyhexamethylene biguanide (PHMB), chlorhexidine. Neomycin-polymyxin B-gramicidin is thought to kill bacteria which provides a food source for the acanthamoeba.  Antifungals include topical and oral preparations of voriconazole as well as ketoconazole, miconazole and clotrimazole

DIFFERENTIAL DIAGNOSIS Acanthamoebic keratitis Pesudomonas keratitis

I gave treatment for sterile keratitis... Started with prednisolone eye drop and symptoms got relieved
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CONTACT LENS INDUCED KERATITIS

May be Acanthomoebic keratitis,can be correlated with severe pain and associated scleritis...

sterile infiltrate...seen with contact lens use low strength topical steroid with antibiotic treatment should improve condition,review biweekly.

I agree
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Probably acanthamoeba.

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