Bilateral Pseudomonas aeruginosa Keratitis in 7 Patients

Abstract

Purpose: To report 7 patients (14 eyes) with bilateral Pseudomonas aeruginosa keratitis (PAK).

Methods: Case records of patients with bilateral PAK were reviewed at a single academic medical center from April 2009 to December 2020.

Results: Seven patients aged 29 to 94 years presented with bilateral P. aeruginosa corneal ulcers. All patients were soft contact lens wearers except one elderly patient with a complex ocular history. Three patients wore specialty contact lens, including one cosmetic contact lens wearer, one multifocal contact lens wearer, and one extended-wear contact lens wearer. The remaining three patients were not overnight contact lens wearer but regularly showered in contact lens or used tap water for contact lens case cleaning. All patients presented with asymmetric disease, with visual acuity ranging from 20/20 to light perception. Ulcers were located centrally in 5 eyes (35.7%), diffusely over the entire cornea in 5 eyes (35.7%), temporally in 2 eyes (14.2%), and nasally in 1 eye (7.14%), and in 1 eye (8.3%), the ulcer location was not recorded. Corneal thinning was noted in 7 eyes (50%). Hypopyon was also noted in 7 eyes (50%). Two patients required procedures because of progressive stromal necrosis. All other patients were treated nonsurgically, with antibiotic drops, which resulted in ulcer resolution. Final visual acuity on last recorded follow-up ranged from 20/20 to no light perception.

Conclusions: This is the largest case series of bilateral PAK, which occurred primarily in contact lens wearer. This case series reiterates the risk of contact lens infection related to poor hygiene.