Persistent infectious keratitis in a contact lens wearer

A 21-year-old female nursing student was referred to Tufts New England Eye Center Cornea Service for a persistent infectious keratitis that was not responding to topical antibiotic therapy.She initially presented to an outside ophthalmologist with 5 days of severe pain, tearing, photophobia and a small infiltrate in the right eye. She was started on Vigamox (moxifloxacin, Alcon) every 2 hours for presumed bacterial keratitis. When symptoms did not improve after 2 days, prednisolone and bacitracin four times daily were added to the regimen. By day 10, her clinical picture had worsened with decreased vision, enlarged infiltrate and prominent conjunctival injection. At this point, her provider obtained corneal cultures and discontinued the steroid drops. On day 13, cultures were still pending, and she was referred to Tufts New England Eye Center for in vivo confocal microscopy (IVCM).