Case reports of three atypical infiltrative keratitis events with high Dk soft contact lens wear

Purpose. We report three atypical infiltrative keratitis events in patients that had successfully worn highly oxygen permeable (Dk) soft contact lenses on an extended wear (EW) schedule for at least 15 months. These cases highlight the role of patient/practitioner education, patient compliance, examination, and appropriate referrals that are required to reduce the risk of complications during lens wear. Methods and Results. Each patient had been wearing high Dk soft lenses on an EW schedule with monthly replacement for at least 15 months and presented with severe pain, redness, and photophobia. The events were characterized by focal infiltrate(s) with an overlying epithelial defect in the superior periphery to mid-periphery of the cornea and extensive diffuse infiltration. Conclusions. The signs and symptoms of each case were more severe than is typically associated with contact lens-related infiltrative keratitis. Because of the slow progression of signs and relatively fast resolution, the cases were not found to be microbial keratitis. Although high Dk soft contact lenses overcome hypoxia-associated complications associated with extended wear, patients and practitioners must be vigilant as adverse events can still occur and in rare instances can be severe. Education and patient compliance are a crucial part of successful management of patients on EW schedules. Constant reinforcement is necessary to ensure patient compliance.