Contact lenses use advice - Risks and outcomes. Are patients drowning in information but starved for knowledge?

Introduction: Microbial keratitis can cause significant visual morbidity and is a common reason for eye casualty attendance. Contact lens wear and poor contact lens hygiene significantly increases the risk of corneal infection.

Objectives: To determine the level of contact lens hygiene awareness amongst contact lens wearers attending our service and determining whether contact lens type and hygiene attitude is related to severity of disease.

Materials and Methods: Prospective questionnaire-based study of 50 consecutive patients attending a tertiary referral's centre eye casualty. All patients were seen at day 0 and 2 weeks post diagnosis. In the interim period, all patients were reviewed in the General Eye Casualty. Patients were divided into subgroups according to contact lens type (monthly, two-weekly, daily and extended day and night wear) and risk group (low, medium and high) depending on their contact lens hygiene practices.

Results:
Thirty-four women and 16 men were included in this study. Twenty-four patients were monthly disposable contact lens wearers, 16 patients were daily disposable contact lens users, 6 patients were using 2-weekly replacement lenses and 4 patients were using extended wear (day and night) contact lenses. Twenty-five patients were diagnosed with corneal ulcer, 23 of which had poor contact lens hygiene to a certain degree. Twenty-two patients had non-infiltrative corneal ulcer keratitis, 1 patient had a small infiltrate with anterior uveitis and 4 patients had a history of corneal abrasion. BCVA significantly improved post treatment. Mean pre-treatment BCVA was 0.24 LogMAR and mean post-treatment BCVA was 0.09 LogMAR (p<0.05).

Conclusion:
Our study highlights the need to improve contact lens hygiene awareness and influence hygiene practices. Patients with the poorest contact lens hygiene had a slower visual recovery and greater incidence of corneal ulcer. Contact lens hygiene advice needs to be clear and reinforced over time.