Clinical response of contact lens-associated fungal keratitis to topical fluoroquinolone therapy.
OBJECTIVE
To report 5 cases of fungal keratitis associated with contact lens wear that resolved or significantly improved without antifungal therapy.


METHODS
Observational case report of 5 patients with a history of contact lens wear who presented with infectious keratitis. Two patients had growth of fungal species on corneal microbiologic cultures, and of the remaining 3 patients, 2 showed fungal elements on confocal microscopy. All 5 patients exhibited growth of fungal species on contact lens microbiologic cultures. All patients received topical fluoroquinolone therapy as initial treatment.


RESULTS
In 3 cases, of whom 2 were treated with moxifloxacin 0.5%, the keratomycosis resolved completely on topical fluoroquinolone therapy. One case was switched to topical tobramycin 14 mg/mL and cefazolin 50 mg/mL with complete resolution of the infection. The final case showed marked initial improvement on fluoroquinolone therapy but was subsequently treated with natamycin 5%.


CONCLUSIONS
Fungal keratitis associated with soft contact lens wear may occasionally present in a less aggressive form. Topical fluoroquinolone therapy may be an adjunct to the innate immune response in eradicating less fulminant keratomycosis.
Munir
Wuqaas M
WM
Bascom Palmer Eye Institute, University of Miami, Miller School of Medicine, Miami, FL, USA.
Rosenfeld
Steven I
SI
Udell
Ira
I
Miller
Darlene
D
Karp
Carol L
CL
Alfonso
Eduardo C
EC
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D001203:Ascomycota / Q000302:isolation & purification*; D001372:Aza Compounds / Q000627:therapeutic use*; D002437:Cefazolin / Q000627:therapeutic use; D003261:Contact Lenses / Q000382:microbiology*; D003315:Cornea / Q000382:microbiology; D003320:Corneal Ulcer / Q000188:drug therapy* / Q000382:microbiology; D015821:Eye Infections, Fungal / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones; D005670:Fusarium / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D018613:Microscopy, Confocal; D000077266:Moxifloxacin; D009181:Mycoses / Q000188:drug therapy* / Q000382:microbiology; D010866:Natamycin / Q000627:therapeutic use; D009883:Ophthalmic Solutions / Q000627:therapeutic use; D011804:Quinolines / Q000627:therapeutic use*; D014031:Tobramycin / Q000627:therapeutic use
D000935:Antifungal Agents; D001372:Aza Compounds; D024841:Fluoroquinolones; D009883:Ophthalmic Solutions; D011804:Quinolines; D010866:Natamycin; D002437:Cefazolin; D000077266:Moxifloxacin; D014031:Tobramycin