Confocal microscopy of contact lens keratitis presenting as central toxic keratopathy.

OBJECTIVES: Central toxic keratopathy (CTK) after refractive surgery is a syndrome characterized by central corneal opacification, thinning, and a hyperopic shift. We report a similar presentation after extended contact lens wear. No prior confocal imaging has been reported in this contact lens case syndrome.
METHODS: A 45-year-old white man presented with 3 weeks of photophobia and foreign body sensation after extended contact lens wear. Initial examination showed central stromal opacities, thinning, and hyperopic shifts, more in the right eye than in the left eye.
RESULTS: Initial confocal microscopy showed collagen fibril edema and rearrangement with cellular infiltration and sparse refractile elements similar in appearance to immunoglobulin. The patient was treated with topical corticosteroids and was told to discontinue contact lenses. At 7 months, there was trace corneal haze, resolved corneal thinning, a 2-D residual hyperopic shift in the right eye, and a 1.5-D shift in the left eye.
CONCLUSIONS: The clinical findings in our patient having contact lens keratitis resemble those of CTK postrefractive surgery cases, suggesting a similar mechanism. The lack of necrotic debris supports a cytokine-triggered apoptosis over an inflammatory cell-mediated necrosis as the cause of stromal tissue loss. Future confocal microscopy at different stages will help clarify the pathophysiologic condition of this rare syndrome.