Article

ONLINE PHOTO DIAGNOSIS

This image shows contact lens-associated infiltrative keratitis (CLAIK) in a patient’s left cornea. The 31-year-old highly myopic patient reported with recent bilateral irritation. He had been wearing PureVision 2 (Bausch + Lomb) on a daily wear basis using Opti-Free Replenish (Alcon) for overnight cleaning and disinfection.

Visual acuity with his lenses was 20/20 in both the right and left eyes. The lenses exhibited adequate centration/coverage and movement. No lens surface deposits were observed. Slit lamp examination showed multiple subepithelial infiltrates in both corneas. The patient did not report any recent illness.

CLAIK has been previously reported as a sterile inflammatory event often associated with the combined use of silicone hydrogel lenses cared for with preservative-based multipurpose disinfecting solutions (MPDS).1 Diffuse subepithelial infiltrates without staining are the hallmark sign. Patients may or may not be symptomatic.

We educated this patient on the findings and gave him the option of switching to a daily disposable modality or a hydrogen peroxide care system. He decided to continue with his current lenses but switched to Clear Care (Alcon). At a one-month follow-up appointment, the patient’s symptoms had improved, and the corneal infiltrates had resolved.

A careful history and examination will help practitioners make an accurate diagnosis of CLAIK. For resolution, switch patients to a daily disposable modality or a hydrogen peroxide care system.

  1. Sacco AJ. Contact Lens-Associated Infiltrative Keratitis and Multipurpose Solutions. Contact Lens Spectrum. 2011 Apr;26:40,42-45.