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

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 substa...