Praxis Medical Insights

Diagnosis and Treatment

Discontinuing all contact lens wear until the cornea returns to normal is recommended for patients with contact lens-related infections, according to the American Academy of Ophthalmology 1
Fortified antibiotics, such as fortified tobramycin (14 mg/ml) or fortified cefazolin or ceftazidime (50 mg/ml), may be necessary for treatment of contact lens-related infections 2
A brief course (1-2 weeks) of topical corticosteroids may be prescribed after infection is controlled for mild cases of contact lens-related infections 1
Topical cyclosporine 0.05% can be considered for longer-term use in cases with significant inflammation 1
Acanthamoeba keratitis should be suspected if moderate to severe pain is present, especially with history of swimming or showering while wearing lenses, and requires prompt treatment 1
Fluoroquinolone antibiotics are the first-line treatment due to their broad-spectrum activity against common pathogens, including Pseudomonas aeruginosa, as recommended by the American Academy of Ophthalmology 3, 2
The following fluoroquinolone concentrations are recommended:

2, 3, 4

Macrolides, such as azithromycin, are particularly useful for chlamydial conjunctivitis 5
Povidone-iodine 1.25% ophthalmic solution may be as effective as topical antibiotics and can be considered when access to antibiotics is limited 6
Azithromycin 1g orally as a single dose is the recommended first-line treatment for bacterial conjunctivitis requiring oral antibiotics, due to its excellent efficacy and convenient dosing regimen, as endorsed by the American Academy of Ophthalmology 1, 2
Alternative treatment options include doxycycline 100mg orally twice daily for 7 days, levofloxacin 500mg orally once daily for 7 days, and amoxicillin 500mg orally three times daily for 7 days, as suggested by the American Academy of Ophthalmology 1

Never using tap water with contact lenses, replacing lens case every 3 months, and never "topping off" old solution with new solution are recommended contact lens care practices to prevent infection 2, 3
Avoiding overnight wear of contact lenses, which increases infection risk 5-fold, is recommended to prevent contact lens-related infections 2, 3
Consideration of alternatives to contact lenses, such as eyeglasses or refractive surgery, is recommended if recurrent infections occur 1
Proper contact lens hygiene is essential, including never using tap water with contact lenses, replacing the lens case every 3 months, and avoiding overnight wear, which increases infection risk 5-fold, as recommended by the American Academy of Ophthalmology 3, 2
Corticosteroids should be used with caution in cases of active infection until infection is controlled, as recommended by the American Academy of Ophthalmology 2, 3, 1
Doxycycline, quinolones, and tetracyclines should be avoided in certain populations, such as pregnant women and children, as cautioned by the American Academy of Ophthalmology 1, 2
MRSA has been isolated with increasing frequency in bacterial conjunctivitis, and microbiology laboratory testing should be considered to guide therapy in resistant cases, as suggested by the American Academy of Ophthalmology 1

If no improvement after 48-72 hours, consider culture and sensitivity testing, evaluation for possible bacterial keratitis, and modification of antibiotic therapy based on clinical response, as suggested by the American Academy of Ophthalmology 6
For standard bacterial conjunctivitis, a return visit in 3-4 days is recommended if no improvement is seen, as per the American Academy of Ophthalmology 1
For gonococcal conjunctivitis, daily follow-up until resolution is recommended, according to the American Academy of Ophthalmology 1
Consider referral for incision and drainage when a stye persists for more than 1 week despite appropriate medical therapy, a large pointing abscess has formed, or severe pain or visual disturbance is present, based on clinical guidelines 7