Diagnosing Corneal Infiltrates

Submitted by Anonymous (not verified) on Mon, 11/23/2020 - 22:08
optometrist examining female patient on slit lamp in ophthalmology clinic

Patient: This morning my left eye was red and irritated. It feels like there is something in my eye. I was doing yard work and I think I got some debris in my eye.

Doctor: Ok, has this happened before?

Patient: No

Doctor: Let me take a look

The doctor examines the eye through a slit lamp and sees:

  • a small gray circular hazy area that is 0.25mm in mid-periphery of the cornea
  • and a conjunctival injection

Doctor: I am going to put dye in the eye to check the integrity of the cornea. Do you have a history of contact lens wear?

Patient: Yes I wear monthly contact lenses.

Doctor: Do you ever sleep in your lenses?

Patient: Yes, a few times a week…if I am being honest.

The doctor looks through the slit lamp again and sees no staining overlaying the gray hazy area

Doctor: Based on what I am seeing it seems that you have a corneal infiltrate which is inflammatory cells that have invaded the front surface of the eye.

Patient: What caused it?

Doctor: In your case, it was probably caused by over wearing your contact lenses and wearing them overnight. By doing this either leads to a bacterial presence or the lens could cause trauma to the front surface that caused an inflammatory response.

Patient: How is it treated?

Doctor: First we want to stop contact lens wear until this resolves. Because there is no staining present I am going to prescribe you an antibiotic/anti-inflammatory combo drop to reduce the inflammation and decrease the risk of infection.

Patient: Okay sounds good.

Doctor: I’ll see you back in 4 days to see if the inflammation has decreased but until then no contact lens wear. Once you resume contact lens wear it’s highly important that you do not wear your contact lens overnight and are better at cleaning the contact lenses. If not this can potentially lead to more serious infections like corneal ulcers which require more aggressive treatment and can be sight-threatening.

Patient: I will definitely do better.

Doctor: See you next week!


Corneal infiltrates are an inflammatory reaction that can be caused by contact lens overwear. Common symptoms are mild to moderate pain/irritation, redness, and mild discharge. It’s important to rule out infectious etiology which can determine the course of treatment. To determine whether antibiotics should be used alone or if a combination sterile antibiotic drop should be used.