Klinische Monatsblatter fur Augenheilkunde · 2006
[Pseudomonas-keratoconjunctivitis in a contact lens wearer, the therapy and keratoplasty á chaud].
Клинический случайАннотация на английскомСтатьяНазвание и аннотация: Перевод в очереди
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Gracner B, Gracner T, Falez M, Pahor D
Аннотация
BACKGROUND: Eye infections in contact lens wearers can cause severe complications. Especially dangerous is Pseudomonas aeruginosa.
PATIENT: A 18-year-old patient who received her first soft contact lens from a optician two years ago without an ophthalmological examination, will be presented. At the time of an excursion to Paris in August 2004 she suffered from a purulent secretion on her right eye. In a pharmacy she bought medicinal herbal eye drops first. Then after three days a physician prescribed her Tobramycin eye drops 4 times per day and Chloramphenicol ointment at bedtime. At that time the visual acuity (VA) of the infected eye was already very bad. Two days later we performed the first ophthalmological examination at our Ophthalmological Department.
RESULTS: The clinical finding was typical for a Pseudomonas infection: mucopurulent secretion, corneal ring abscess with stromal necrosis and hypopyon. The VA was only light perception. Immediately, a topical and systemic antibiotic therapy was prescribed (grade III by W. Behrens-Baumann). A conjunctival smear was sterile. For the microbiological examination the corneal scraping, the contact lens and storing solution were also taken and Pseudomonas aeruginosa and Klebsiella spp. were isolated. One month after the first presentation of the patient at our Department we performed a keratoplasty á chaud (diameter 8.0 mm). 1 year later the corneal graft is clear and the VA is 0.6 - 0.7 cc.
CONCLUSIONS: The contact lens fitting lies worldwide in different hands and could be done by an ophthalmologist, an optometrist or an optician. The changes of the cornea and conjunctiva made by contact lenses can have different causes. Especially dangerous are metabolic-hypoxic corneal changes and infections. Therefore, an ophthalmological check-up, particularly after contact lens fitting done by an non-physician, is very important and necessary.
PATIENT: A 18-year-old patient who received her first soft contact lens from a optician two years ago without an ophthalmological examination, will be presented. At the time of an excursion to Paris in August 2004 she suffered from a purulent secretion on her right eye. In a pharmacy she bought medicinal herbal eye drops first. Then after three days a physician prescribed her Tobramycin eye drops 4 times per day and Chloramphenicol ointment at bedtime. At that time the visual acuity (VA) of the infected eye was already very bad. Two days later we performed the first ophthalmological examination at our Ophthalmological Department.
RESULTS: The clinical finding was typical for a Pseudomonas infection: mucopurulent secretion, corneal ring abscess with stromal necrosis and hypopyon. The VA was only light perception. Immediately, a topical and systemic antibiotic therapy was prescribed (grade III by W. Behrens-Baumann). A conjunctival smear was sterile. For the microbiological examination the corneal scraping, the contact lens and storing solution were also taken and Pseudomonas aeruginosa and Klebsiella spp. were isolated. One month after the first presentation of the patient at our Department we performed a keratoplasty á chaud (diameter 8.0 mm). 1 year later the corneal graft is clear and the VA is 0.6 - 0.7 cc.
CONCLUSIONS: The contact lens fitting lies worldwide in different hands and could be done by an ophthalmologist, an optometrist or an optician. The changes of the cornea and conjunctiva made by contact lenses can have different causes. Especially dangerous are metabolic-hypoxic corneal changes and infections. Therefore, an ophthalmological check-up, particularly after contact lens fitting done by an non-physician, is very important and necessary.