Intended for healthcare professionals

Endgames Case Review

Painful red eyes in a contact lens wearer

BMJ 2017; 358 doi: (Published 14 September 2017) Cite this as: BMJ 2017;358:j3614

This article has a correction. Please see:

  1. Katherine McVeigh, ophthalmology registrar,
  2. Kaveh Vadhani, ophthalmology fellow,
  3. Shokufeh Tavassoli, ophthalmology registrar,
  4. Derek Tole, corneal consultant
  1. Bristol Eye Hospital, Bristol, UK
  1. Correspondence to K McVeigh katherine.mcveigh{at}

A 21 year old woman from Singapore presented to the eye hospital with a two week history of painful red eyes, where the severity of the pain was continuing to worsen. She was short-sighted and wore rigid gas permeable contact lenses on most days and admitted to sometimes sleeping with them in situ. She had last worn contact lenses a week before presentation. She reported that she had been cleaning the lenses with tap water over the past two months, including during a holiday in Thailand. She had not been unwell recently, in close proximity to anyone with conjunctivitis, or been subject to trauma. No previous ophthalmic or medical history was noted.

On examination, the best corrected visual acuity was 6/36 right eye and 6/9 left eye, tested with glasses. The conjunctival vessels were diffusely injected. The corneas stained bilaterally in a punctate fashion with fluorescein over a patchy area of whitish haze within the centre and mid peripheries (fig 1).

Fig 1 Colour photograph of the right and left eye on the day of presentation captured using a slit lamp. Whitish hazy patches of infection and injected conjunctival blood vessels are noted bilaterally


  • 1. What differential diagnoses need to be considered?

  • 2. How would you manage this patient?

  • 3. How can patients reduce complications with contact lens wear?


1. What differential diagnoses need to be considered?

Short answer

The most likely diagnosis is a contact lens related microbial keratitis, which is usually caused by bacteria. However, with no improvement on antibiotics, acanthamoeba should be …

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