Response to Thyagarajan et al's audit: “An audit of corneal abrasion management following the introduction of local guidelines in an accident and emergency department.”

We read with interest the audit by Thyagarajan et al¹ of corneal abrasion management after the introduction of local guidelines in an accident and emergency department, and believe it is worth specifically highlighting why it is so important to ask about contact lens use in the history as illustrated by the following case:

A 30‐year‐old contact lens wearer recently presented with a 2‐day history of a painful, red left eye. Topical chloramphenicol had been started 24 h before for a corneal abrasion. The best corrected visual acuity of her left eye was counting fingers. Examination showed a severe central corneal ulcer. The patient was admitted for intensive topical ofloxacin. Culture results showed Pseudomonas aeruginosa, resistant to chloramphenicol. Four months later, the best corrected visual acuity of her left eye was 6/18 due to residual stromal scarring.

Contact lens use is the most important risk factor for the development of microbial keratitis,²,³ a potentially sight‐threatening condition if correct treatment is not started promptly. In a 15‐year retrospective review of antibiotic resistance in bacterial keratitis in London, >30% of the isolates were resistant to chloramphenicol,⁴ the usual prophylactic treatment in the UK for corneal abrasions. The incidence of chloramphenicol resistance increased markedly during the study period, and is attributable to an increase in the proportion of Pseudomonas species isolates,⁴ which are the most frequently found organisms in contact lens‐related corneal ulcers.⁵

As the early signs of microbial keratitis can be subtle, we recommend that all contact lens wearers who have a red, sore eye with a corneal epithelial defect should be referred to the eye unit for urgent assessment.