A 32-year-old contact-lens wearer presents to the emergency department with eye pain, redness, and photophobia in her right eye. She reports sleeping in her contact lenses for the past week. On examination, you note a small, grayish-white lesion on the cornea. What is the most likely diagnosis?
Bacterial keratitis is strongly associated with contact-lens use, particularly when lenses are worn overnight. Patients typically develop acute pain, redness, photophobia, and a gray-white corneal infiltrate (ulcer). Fungal keratitis is usually slower in onset and more often follows trauma with vegetative matter. A corneal abrasion produces an epithelial defect that stains with fluorescein but does not create a stromal infiltrate. Herpes simplex keratitis often presents with a branching (dendritic) epithelial ulcer rather than a discrete white infiltrate. Prompt ophthalmology referral and empiric broad-spectrum antibiotic drops are essential to prevent vision loss.
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Maxillofacial and Ocular Emergencies
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