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

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

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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

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 ).

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

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

Probably acanthamoeba.

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