Can the 48-hour review of less severe contact lens-related keratitis become a virtual review?

Session Details

Session Title: Presented Poster Session: Infections & Syndromes

Venue: Poster Village: Pod 3

First Author: : A.Okonkwo UK

Co Author(s): :    L. Sansom   S. Naylor                    

Abstract Details

Purpose:

With increasing population density in the UK there is a drive to make efficiency savings within healthcare. Contact lens related keratitis predominantly effects young patients with no significant past ocular history. Initial treatment is with high frequency broad spectrum topical antibiotics, individuals are then assessed clinically for treatment response, typically after 48 hours. If a change (or lack of) in ocular discomfort correlates with clinical signs at first review in less severe contact lens related keratitis, these patients can potentially receive telephone reviews, reducing number of hospital attendances.

Setting:

Eye casualty departments in both Hull Royal Infirmary, UK and Bradford Royal Infirmary, UK.

Methods:

6-month interim report of 12-month study of patients attending seen by 3 ophthalmology trainees and 2 nurse practitioners at two different sites in eye casualty. Contact lens related keratitis presenting with ocular pain and <1.5mm infiltrate were included; those that had corneal scrapes or in which there was clinical suspicion of acanthamoeba keratitis were excluded.

Results:

Fifty-seven eyes of 56 patients were included. Mean duration of ocular pain prior to presentation was 3 days (range 1-28). Hourly 0.3% ofloxacin was used in 56 (98%) eyes and hourly 0.5% levofloxacin in 1 (2%). Mean time to followup review was 2 days (range 1-7). Fifty-five (96%) eyes had reduced ocular discomfort; all had clinical improvement. Two (4%) eyes had no improvement/worsening ocular discomfort; 1 showed clinical improvement and 1 was diagnosed with acanthomoeba keratitis. Mean number reviews to discharge was 3 (range 2-5). One patient with reduced ocular discomfort at first review developed recurrent corneal erosion syndrome.

Conclusions:

Change in ocular discomfort correlates well with clinical signs in less severe contact lens related keratitis. Virtual review of ocular discomfort alone may be a safe way to reduce eye casualty attendances without missing acanthomoeba keratitis. Exceptions include but are not limited to where early review is indicated to start topical steroids for lesions that involve the visual axis.

Financial Disclosure:

None