What is a common initial management step for both CLARE and infiltrative keratitis?

What is a common initial management step for both CLARE and infiltrative keratitis?

• A. Discontinue contact lens wear
• B. Prescribe continuous wear with antibiotics
• C. Increase lens wear time
• D. Ignore symptoms

Answer: (A)

The key idea is that stopping the factor driving the problem—wearing the contact lens—is the essential first step. In both CLARE and infiltrative keratitis, the corneal irritation or infection is worsened by ongoing lens wear, which sustains hypoxia, mechanical rubbing, and a reservoir for contaminants. Removing the lenses cuts off that loop, relieves the ongoing stress on the cornea, and allows healing to begin. After the lens is removed, clinicians can assess the cornea more clearly and decide on further treatment, such as appropriate eye drops or antibiotics if infection is suspected. Continuing to wear lenses, prescribing uninterrupted lens wear with antibiotics, or ignoring symptoms would all risk progression and poorer outcomes, so stopping lens wear up front is the best initial management step.

The key idea is that stopping the factor driving the problem—wearing the contact lens—is the essential first step. In both CLARE and infiltrative keratitis, the corneal irritation or infection is worsened by ongoing lens wear, which sustains hypoxia, mechanical rubbing, and a reservoir for contaminants. Removing the lenses cuts off that loop, relieves the ongoing stress on the cornea, and allows healing to begin. After the lens is removed, clinicians can assess the cornea more clearly and decide on further treatment, such as appropriate eye drops or antibiotics if infection is suspected. Continuing to wear lenses, prescribing uninterrupted lens wear with antibiotics, or ignoring symptoms would all risk progression and poorer outcomes, so stopping lens wear up front is the best initial management step.