Posters

A case report: a contact lens related microbial keratitis secondary to pseudomonas aeruginosa management in a second-trimester pregnant patient

Poster Details

First Author: K.Rifai MOROCCO

Co Author(s): S. Moutamani   A. Amazouzi   L. Cherkaoui              

Abstract Details

Purpose:

We present the case of a 17-week pregnant patient with a contact lens related microbial keratitis. It discusses the differential diagnosis, risk factors and pharmacological treatments for corneal ulcers as well as the educational component necessary to transfer the information from a didactic to a clinical setting, especially during pregnancy .This topic is important to talk about because of the potentially sight-threatening consequences of corneal ulcers and keratitis.

Setting:

The contact lens related corneal infections can cause permanent blindness. The diagnosis is established by a meticulous examination. During pregnancy, you have to prevent the teratogenicity risk and the visual sequels. This case has been reported in the ophtalmology department A in the university hospital of Rabat in september 2019.

Methods:

The following case report involves a 25 years old 17-week primigravida African female who developed a corneal ulcer after falling asleep in her contact lenses and storing them in tap water. She presented to a tertiary referral center complaining of light sensitivity, redness, and pain in her right eye.The ophthalmological examination included a measure of visual acuity using Snellen’s distance vision chart. Specimens of corneal scraping and contact lenses were sent for culture and sensitivity tests. We did a complete and bilateral slit lamp microscopic examination of the anterior and the posterior segment with measurement of the eye pressure.

Results:

The right eye visual acuity was 1/10. We found conjunctival hyperemia, a round, deep, well demarcated white epithelial defect with stromal excavation 3mm*3mm in the visual axis with positive fluorescein staining, corneal œdema and hypopion. The anterior chamber revealed a grade 2 cells and flare with normal intraocular pressure. The vitreous and retina were normal at the ocular ultrasound. We used moxifloxacin, cyclopentolate and reinforced eye drops based on ceftazidim and vancomycin with lacrymal occlusion to reduce the teratogenicity risk.The corneal culture shows that the infection was secondaty to Pseudomonas Aeruginosa sensitive to ceftazidim.The patient refused the punctal plugs.

Conclusions:

With the increasing popularity of contact lens wear, contact lens related corneal ulcer or keratitis are becoming more prevalent. Risk factors are multiple as continuous wear and poor hygiene. The presenting symptoms of contact lens related corneal infections include a simple eye discomfort; or more serious symptoms as redness and blurring of vision. Early diagnosis and treatment is paramount to prevent permanent visual impairment. Lacrimal occlusion with punctal plugs is one of the options available in cases of pregnant patients to reduce the risk of teratogenicity.Ophthalmologists, contact lens providers and contact lens users should work jointly to solve this issue.

Financial Disclosure:

None