Contact lens-related microbial keratitis increasing in children

This study found an increase in contact lens–related microbial keratitis in children, especially among those who use orthokeratology.

This article is important as studies tend to focus on the epidemiology of microbial keratitis in adults instead of kids. This study highlights the potential complications of contact lens wear in pediatric patients, especially in those using orthokeratology.

The authors retrospectively compared the epidemiology of microbial keratitis in 78 pediatric patients (aged 16 years or less) seen from 1998 to 2002 with 67 pediatric patients seen from 2008 to 2012 at the same hospital in Taiwan.

They found that the leading risk factor for microbial keratitis during both time periods was contact lens use. Furthermore, the infection rate due to contact lenses significantly increased from 41 percent to 53 percent (P = 0.024), which was mainly attributable to the recent increase in the rate of orthokeratology-related keratitis from 10 percent to 19 percent (P = 0.011).

Pseudomonas aeruginosa was the most commonly isolated organism in both groups, but the frequency of coagulase-negative Staphylococcus cases increased significantly in the latter group. Bacterial antibiotic susceptibility did not change significantly between the two study periods. Infection with gram-negative bacteria was associated with worse visual outcomes.

The authors note that the high prevalence of myopia in Asian children and adolescents has increasingly popularized contact lens use not only for refractive correction but also for cosmetic reasons, which may elevate the risk of pediatric microbial keratitis. More than one-third of the patients in the later time period who wore contact lenses used overnight keratology.

They conclude that although contact lens use is a leading and widely recognized risk factor for pediatric microbial keratitis in Taiwan, people still overlook this risk that can potentially impair vision. The researchers recommend that eye-care practitioners warn patients and their caregivers of this potential complication and educate them about proper and hygienic use of soft contact lenses and overnight orthokeratology.