Contact Lens Infections: a Risk of Contact Lens Wear. LASIK Can Be Performed After Contact Lens Infection and Corneal Ulcer

While LASIK is not risk free, contact lens — particularly extended wear (overnight) contact lense — carry a risk of infection. In many cases, LASIK can be performed after the contact lens infection is resolved.

Many people appropriately weight the risk of LASIK when considering vision correction options. Fewer, however, give equal consideration to the risk of one major alternative to laser eye surgery — the risk of wearing contact lenses. If someone develops a contact lens related corneal infection, unfortunately it is possible for the cornea to develop an ulcer and even a scar from the infection.

Recently, the SUNY Downstate Current Concepts in Ophthalmology meeting featured a lecture on the latest data and concepts in contact lens infection risk. Douglas Lazzaro, M.D. noted the risk is about 5 – 20 cases of infection per 10,000 daily wear contact lens users. Dr. Lazzaro noted that the main risk factors for contact lens infection include oxygen deprivation (hypoxia), poor contact lens fit, and use of extended wear (overnight) contact lenses. Other factors that increased the risk of contact lens infection include diabetes, steroids, and tobacco use.

Dr. Lazzaro noted that the most common cause of infection in contact lenses is bacteria, although fungal infections can happen as well. One of the most common bacteria that can cause infection in contact lens users is Pseudomonas, which is a particularly harmful bacteria that can cause a great deal of damage to the eye — even blindness — in a relatively short time. Unfortunately, as Dr. Lazarro noted, Pseudomonas lately is developing resistance to many important eye antibiotics and it can even make a biofilm that makes it resistant to anti-microbial agents. By contrast, Pseudomonas infections are much less common in LASIK interestingly. Another bacteria that can cause contact lens infections is Staphylococcus (“Staph”), including the famous drug-resistant form known as MRSA (“Methacillin Resistant Staphylococcus Aureus”).

Dr. Lazzaro noted the most common fungal infection seen with contact lens use is Fusarium solani. Typically this organism is found on decaying vegetation. Dr. Lazzaro noted that some patients who develop fungal infections with contact lens use end up needing a corneal transplant. Fortunately, fungal infections account for only about 1% of contact lens infection according to Dr. Lazzaro.

Perhaps the most important take home message for patients in Dr. Lazzaro’s talk is that extended wear (overnight) contact lenses carry a higher risk of infection, even in lenses approved for overnight wear. Daily wear contact lens use is preferred in my opinion over extended wear use, although it is very reasonable to use extended wear contact lenses on a daily basis.

I have had many patients over the years who have come to see me for LASIK laser eye surgery after recovering from a contact lens infection. The infection had served as a “wake up call” that contact lenses are not risk free. In general, many patients who develop contact lens related infection should either stop wearing contacts or dramatically reduce their use as many of these patients continue to exhibit the same risk factors after their infection (such as poor contact lens fit or hypoxia). Certainly, depending on the degree of scarring, LASIK can be performed in many cases after someone has had a contact lens infection. It is important that the infection be completely resolved and, in general, I like to wait a minimum of 3 months after the contact lens infection is resolved before performing LASIK. If the corneal scar from the contact lens infection covers the center of the pupil, however, LASIK may not be able to help.

See Also

LASIK After Contact Lens Infection
See With LASIK blog about the role of LASIK after contact lens infection.

LASIK versus Contact Lenses
Oregon Health and Sciences University’s Case Eye Institute discuss of the relative risks and benefits of contact lens use compared to LASIK.

30 Day Contacts – A Smart Alternative to LASIK?
All About Vision discussion of the real world risks of extended wear contact lenses.

Risk of LASIK Surgery versus Contact Lenses
Article from the Archives of Ophthalmology comparing relative risk of LASIK versus contact lenses

Contact Lens Infection Nearly Blinds High Schooler Ashley Hide: How Dangerous Are They
A story on the Huffington Post about a tragic episode of a contact lens infection in a high school age girl.

Focusing on Contact Lens Safety
FDA website review of risks of contact lens safety.

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