Anterior Segment and the eyelids:
                   Case Forty

This 50 year-old female contact lens wearer presented with a one-day history of severe right eye pain. She attended the eye casualty two day earlier with a contact lens-related corneal abrasion and was prescribed topical chloramphenicol qds.

a. What is the most likely pathogen causing this appearance?

Pseudomonas especially pseudomonas aeruginoa.

This is the most common pathogen in contact lens-related microbial keratitis. It is commonly seen in the biofilms of the contact lenses and also in contact lens cases.
It often presents with a rapidly progressive corneal ulcer with large epithelial defects, dense anterior stromal infiltration and mucoid material clinging to the lesion

b. Was the patient given the right antibiotic cover in her first visit?


Pseudomonas aeruginosa is resistant to chloramphenicol but sensitive to gentamicin and fluoroquinolone such as ofloxacin or ciprofloxacin. In any patient with contact lens-related abrasion, antibiotic prophylaxis should either be gentamicin or a fluoroquinolone.

c. How would you manage this patient?

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