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Aim: To analyze the demographics, risk factors, clinical and microbiological characteristics of cases of bilateral simultaneous infective keratitis., Methods: In this retrospective case series, patients with clinical evidence of bilateral simultaneous infective keratitis were identified from January 1, 2011 to August 31, 2016. Demographics, risk factors, clinical and microbiological characteristics, and treatment outcomes were analyzed., Results: Five patients (ten eyes) with bilateral simultaneous infective keratitis were identified. The mean age was 32.8 years (SD,±8.8; range, 24-44). All the patients were disposable soft contact lens wearers before presentation. The average size of the infiltrate was 4.76mm 2 (SD±9.0; range, 0.2-31.34). A total of 4 types of bacteria were isolated, with Pseudomonas aeruginosa being the most frequently isolated bacteria involving 5 eyes of four patients. Infection resolved with medical treatment in 9 eyes, 1 patient required therapeutic corneal transplantation for impending corneal perforation. The average time taken for infection to resolve was 6.7days (SD±4.5; range, 2-16)., Conclusions: In this case series, the most common risk factor of bilateral simultaneous microbial keratitis was use of soft disposable contact lens and the most commonly isolated bacteria was Pseudomonas aeruginosa. Bilateral simultaneous infective keratitis is uncommon and is a serious complication of contact lens use in immunocompetent adult patients., (Copyright © 2017 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Objective: To analyze the demographics, risk factors, and clinical and microbiological characteristics of triple infection keratitis., Design: Retrospective case series., Participants: Five patients (five eyes) with triple infection keratitis were identified., Methods: Eyes with polymicrobial keratitis were identified from January 2002 to December 2010. Only culture-positive cases and eyes infected by three different organisms were included. Demographics, risk factors, clinical and microbiological characteristics, and treatment outcomes were analyzed., Main Outcome Measures: The size of the corneal infiltrate, presence of hypopyon, pre- and post-treatment best-corrected visual acuity, antibiotic regimen and sensitivity, types of isolated pathogens, duration of infection, and treatment outcomes., Results: The mean age was 39 years (SD, ±23.4; range, 21-74). Use of topical steroids was the commonest risk factor (80%). Multiple risk factors were identified in four eyes. The average size of corneal infiltrate was 23.5 mm (SD, ±35.2; range, 2.08-85.5), and all eyes developed hypopyon. A total of 15 organisms belonging to 10 species (bacteria=7, fungi=3) were isolated. Pseudomonas aeruginosa and Candida albicans were the most frequently isolated bacteria (n=3) and fungi (n=3), respectively. All patients had at least one type of fungal isolate. Infection resolved with medical treatment in four eyes and one eye had to be eviscerated as the patient developed panophthalmitis. The average time taken for infection to resolve was 30 days (SD, ±19.3; range, 13-61)., Conclusions: A high index of suspicion of polymicrobial keratitis should be made in patients with multiple and systemic risk factors. Use of topical steroid was the most common risk factor. Prolonged course of disease, relatively large infiltrate, and presence of hypopyon and fungal isolates are typical features of triple infection keratitis.

Objectives: To compare the risk factors, clinical characteristics, microbiological profile, and treatment outcomes of polymicrobial versus monomicrobial keratitis., Methods: In this retrospective comparative case series, eyes with polymicrobial and monomicrobial keratitis were identified from microbiological records at a tertiary academic referral center, from January 2002 to December 2010. Only culture positive cases were included. Eyes with infectious keratitis involving two or more pathogens were included in the polymicrobial group, whereas eyes infected solely by Pseudomonas aeruginosa were included in the monomicrobial group. Various parameters including demographics, risk factors, clinical and microbiological characteristics, and treatment outcomes were analyzed., Results: Twenty-one eyes each with polymicrobial and monomicrobial keratitis were included in this study. The mean age of polymicrobial patients was significantly higher than monomicrobials. Use of contact lens was the commonest predisposing factor in both groups. Systemic (23.8%) and multiple (33.3%) risk factors were involved in eyes with polymicrobial keratitis only. The mean size of corneal infiltrates and mean duration for resolvement of infection were significantly greater in the polymicrobial group. Medical treatment was successful only in 80.9% eyes with polymicrobial keratitis, whereas all monomicrobial keratitis patients responded to it. A total of 44 organisms belonging to 18 species (bacteria = 13, fungi = 5) were isolated from the polymicrobial group. P. aeruginosa and Candida albicans were the most frequently isolated bacteria (n = 12) and fungi (n = 5), respectively. In the polymicrobial group, gram-negative organisms were most sensitive to gentamicin (87.8%), followed by ciprofloxacin (78.7%), whereas gram-positive organisms were 100% sensitive to ciprofloxacin and cefazolin., Conclusions: A high index of suspicion of polymicrobial keratitis should be made in patients with multiple and systemic risk factors. Contact lens usage was the most common risk factor in both groups. Size of corneal infiltrate is a fairly reliable indicator for suspecting polymicrobial keratitis. Prolonged course of the disease and decreased antibiotic sensitivity were the other notable features of polymicrobial keratitis.

Objective: To report an unusual case of keratitis in a cosmetic contact lens wearer caused by two rare organisms., Method: Case report., Results: A 14-year-old cosmetic contact lens user presented with a paracentral corneal ulcer in her right eye. The cosmetic lenses were bought online. The cultures from corneal scrapings and contact lenses demonstrated heavy growth of Chryseobacterium meningosepticum and Delftia acidovorans. The treatment with topical ciprofloxacin and fortified gentamicin was effective, and the infection resolved with corneal scar after 5 weeks., Conclusion: Use of cosmetic contact lenses and buying them online is a fairly common practice among teenagers. This can lead to serious eye infection as in this case. To our knowledge, this is the first report of contact lens-related keratitis simultaneously involving these two rare organisms.