UK researchers suggest new management protocol for contact lens-associated keratitis

Moorfields Eye Hospital clinicians have outlined a new evidence-based management protocol for contact lens-associated keratitis (CLAK).

Writing in British Journal of Ophthalmology, researchers analysed the outcomes of 153 patients with CLAK who presented to the Moorfields Eye Unit of St Georges Hospital between July 2021 and February 2022.

On the basis of this analysis, they recommend that grade 1 and grade 2 CLAKs can be discharged with empirical fluoroquinolone treatment.

However, the researchers emphasised that Grade 3 CLAKs and all CLAKs with atypical features require monitoring for resolution, further diagnostics or treatment.

This suggested protocol differs from the current approach, where patients are reviewed within 48 hours regardless of severity.

The authors highlighted that this approach creates a burden on the resource-limited NHS.

“Our study provides a safe, evidence-based management protocol to improve resource allocation by reducing the number of reviews in low-risk patients which comprise the majority of patients with CLAK,” they shared.

Among the patients included in the analysis, following an empirical treatment regime with topical moxifloxacin 96% of grade 1 CLAKs were discharged within 48 hours, while 94% of grade 2 CLAKs were discharged within two weeks.

Grade 3 CLAKs, and those with atypical features, required a prolonged average duration of treatment.

Within the study, the most significant factors for CLAK were extended-wear contact lens, poor hygiene and prolonged duration of wear.

The researchers highlighted that previous research has shown corneal presentations account for around one in five (18%) eye casualty presentations, while around half of microbial keratitis presentations are secondary to contact lens wear.

“We provide an evidence-based approach to reduce unnecessary patient visits and optimise resource allocation in an urban setting,” the authors emphasised.