Pseudomonas aeruginosa Corneal Ulcer Related to Overnight Orthokeratology

Background: Overnight orthokeratology was thought to be a safe and non-invasive alternative for low-grade myopia and astigmatism correction. We assessed histories, clinical courses, and visual outcomes of the patients with pseudomonal keratitis related to overnight orthokeratology. Methods: The records of six patients with pseudomonal keratitis related to overnight orthokeratology were reviewed from January 2001 through December 2002. Results: The average age of the patients was 13 years. The average period between the time that the patient started the overnight orthokeratology program and the onset of infectious keratitis was 17 months. All patients presented with painful red eyes. The area of the corneal ulcer was central in three, and paracentral in three eyes. The corneal infiltrate was small in one eye, and medium in five eyes. The corneal scrapings from these six patients revealed Pseudomonas aeruginosa. All patients responded well to topical antibiotic treatment. Two of six eyes had a final visual acuity within two lines of the pre-infection vision at the last follow-up. Four of the eyes examined lost their best-corrected visual acuity due to central corneal scar or irregular astigmatism. Conclusions: Overnight orthokeratology contact lens wear has the potential complication of pseudomonal keratitis and may cause significant visual impairment.