Corneal Ulcers Associated With Disposable Hydrogel Contact Lenses James P. Dunn, Jr., M.D., Bartly J. Mondino, M.D., Barry A. Weissman, O.D., Paul B. Donzis, M.D., and Don O. Kikkawa, M.D. Four patients developed corneal ulcers asso- ciated with the use of disposable extended- wear hydrogel contact lenses. Bacteria were recovered from corneal ulcers in three of the patients. Three patients discarded their con- tact lenses after ten or more days of extended wear; the corneal ulcers in these patients developed toward the end of the wearing cy- cle. The fourth patient removed her contact lenses every two days for cleaning and disin- fection and discarded them for a new pair on a weekly basis. Improper lens hygiene was noted in only one patient. All corneal ulcers responded to antibiotic treatment. In three patients visual acuity returned to normal, but scarring of one patient's cornea resulted in a visual acuity of 20/60. CORNEAL ULCERS are the most serious compli- cation of contact lens wear. All types of contact lenses have been associated with infectious corneal ulcers, including cosmetic daily- and extended-wear hydrogel lenses.I" aphakic lens- es/,S,6 therapeutic hydrogel lenses.v? cosmetic lenses used to change eye color," and rigid lenses.r" Corneal ulcers related to contact lens wear now form a growing percentage of all corneal ulcers.v" Hydrogel contact lenses may pose a greater risk of corneal infection when used on an extended-wear rather than a daily- wear basis. 1,3,4,6,9 The use of contact lenses may be associated with breakdown of the corneal epithelial barrier Accepted for publication May 8, 1989. From the Department of Ophthalmology and Jules Stein Eye Institute, UCLA School of Medicine, Los Angeles, California. This study was supported in part by National Eye Institute grant EY04606, the Frances Howard Goldwyn Fellowship Fund, and the Wasserman Fund. Reprint requests to Bartly J. Mondino, M.D., Jules Stein Eye Institute, 800 Westwood Plaza, Los Angeles, CA 90024. as a result of chronic hypoxic stress or manipu- lation of the lens during insertion or removal. Bacteria normally present in the eye or contam- inating some aspect of the contact lens care system may then gain access to the corneal stroma and induce infection. Contamination may result from noncompliance with accepted principles of lens care and has been noted in contact lens wearers who are asymptomatic's" or who have corneal ulcers.1 Disposable extended-wear hydrogel contact lenses, intended to be worn continuously for one or two weeks and then discarded, may reduce problems caused by noncompliance with good lens care since no lens cleaning or disinfection is required. Furthermore, the risks associated with aging lenses, including cracks or other surface defects that might allow micro- bial penetration or deposits which might facili- tate bacterial adherence," should be reduced. Other potential benefits include the elimination of some of the allergic and toxic complications of contact lens care products and a possible decrease in the incidence of giant papillary conjunctivitis. A premarket study of the Acuvue disposable hydrogel contact lens (etafilcon, 58% water content), consisting of 733 patients followed up for eight months of wear, found an overall complication rate of only 5.6%.13 No corneal ulcers were noted. We examined four patients who developed corneal ulcers while wearing Acuvue disposable extended-wear contact lenses. Case Reports Case 1 A 40-year-old woman had been using dispos- able hydrogel contact lenses on an extended- wear basis for three months. She replaced the lenses every 11 to 14 days. Before using dispos- able lenses, she had used daily-wear hydrogel lenses sporadically for six years. She changed ©AMERICAN JOURNAL OF OPHTHALMOLOGY 108:113-117, AUGUST, 1989 113