Clinical management of infectious contact lens complications: from antibiotics to quorum-sensing inhibitors

Abstract

Although effective drugs have become available, improvements in the treatment of contact lens-associated microbial keratitis are required. Over the last decade, the outcome of contact lens-associated bacterial keratitis has improved owing to fluoroquinolones, leading to a better control of infection, earlier institution of anti-inflammatory therapy and surgical intervention. The antimicrobial effectiveness of some antibiotics may be increased by preservatives. Antibiotic resistance according to serum standard limits has not been found to be relevant for the eye, with the exception of methicillin-resistant Staphylococcus aureus. Newer antifungals (voriconazole, itraconazole) are being evaluated, but the mainstay is liposomal amphotericin B and econzole or natamycin. Therapy for acanthamebic (biguanides and combinations) and microsporidial (fluoroquinolones) infections remains unchanged. New hydrophilic contact lens materials may slow down the formation of biofilm. Antibiofilm research has introduced substances that interfere with quorum sensing, and affect enzymatic and peptide-mediated matrix dispersal. Nanotechnology will be used to penetrate the biofilm matrix as well as nanoetching to prevent biofilm development on surfaces. Management of contact lens keratitis comprises of management of the biofilm. Early aggressive antimicrobial treatment, and surgery in certain cases, have resulted in better outcomes. The role of corticosteroids seems beneficial, but has to be further studied. Further improvements rely on biofilm-active agents added to antimicrobials.

Keywords::

• Acanthamoeba
• biofilm
• contact lens
• fluoroquinolones
• Fusarium
• keratitis
• microsporidia
• nanotechnology
• P. aeruginosa
• quorum sensing

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.