Contact Lens-associated Fungal Keratitis Presents Earlier, Fewer Comorbidities

All contact lens-associated keratitis cases resolved with medical therapy alone. This difference between groups may reflect earlier presentation in the contact lens group and more timely initiation of antifungal therapy. In contrast, the higher prevalence of structurally compromised corneas in the non-lens group likely contributed to the greater need for surgical intervention. Photo: Delaney Kent, OD. Click image to enlarge. Fungal keratitis remains a challenging form of infectious keratitis, often marked by delayed diagnosis and variable outcomes. Although it has traditionally been associated with trauma and ocular surface disease, contact lens use has emerged as an important and distinct risk factor.Researchers at the UPMC Vision Institute at the University of Pittsburgh School of Medicine recently characterized the demographic, clinical, microbiological and treatment features of fungal keratitis over an eight-year period at a tertiary referral center in the northeastern United States and compared contact lens-associated cases with those without contact lenses. They found that, despite comparable treatment approaches, outcomes differed, as all contact lens-associated cases resolved with medical therapy alone, while a subset of non-contact lens cases required surgical intervention, suggesting a more complex disease course in this group.Demographic, clinical, microbiological, treatment and outcome data were analyzed and compared between two groups, which comprised 16 contact lens and 21 non-contact lens cases.Contact lens users presented earlier than non-lens patients (median seven vs. 14 days) and had fewer associated ocular risk factors (31% vs. 81%). Baseline visual acuity and infiltrate size did not differ significantly between groups. Candida species were isolated in 21% of cases, Fusarium in 16% and Aspergillus in 8%. Fusarium (19% vs. 13%) and Candida (24% vs. 19%) infections were slightly more frequent in non-lens cases.Overall, filamentous fungi were the predominant organism group. Topical voriconazole was the most frequently used antifungal agent (78%), which the study authors noted likely reflects institutional practice patterns, the medication’s favorable corneal penetration and its broad antifungal spectrum. All contact lens-associated cases resolved with medical therapy alone, with a median time to resolution of 38 days. In contrast, 76% of non-lens cases resolved medically (median 42 days), while 23% required therapeutic keratoplasty. Final visual acuity was comparable between groups (logMAR 0.2 vs. 0.5).The researchers suggested that earlier presentation among contact lens cases in this study may reflect greater patient awareness of lens-related complications and more rapid recognition of symptoms such as pain, redness and visual disturbance. Routine contact lens use, along with education about infection risk, may also encourage earlier healthcare-seeking behavior.“In contrast, non-contact lens cases may present later due to lower clinical suspicion for infectious keratitis and a more insidious onset in structurally compromised corneas,” they wrote in their paper, which was published in American Journal of Ophthalmology.Broader analyses of contemporaneous outbreaks, including Acanthamoeba, further suggest that many solutions were less effective against non-bacterial pathogens. These events underscored the importance of surveillance systems, particularly at tertiary care centers, in identifying emerging infection patterns and prompted changes in product regulation, recall practices and clinical awareness.“These findings underscore the important role of baseline ocular status in shaping disease course and treatment outcomes in fungal keratitis,” the researchers concluded.Click here for the journal source. Kate A, Wannapanich T, Mandell J, et al. Impact of contact lens use on clinical profile and outcomes of fungal keratitis: an eight-year retrospective study. Am J Ophthalmol. June 13, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.