Corneal erosions in contact lens wear

Contact lens wear continues to be the highest single risk factor for microbial keratitis, particularly when worn in the extended wear modality. For microbial keratitis to occur, the presence of at least a bacterial load as well as a break in the corneal surface is required. One such break occurs in the case of a corneal erosion. These well-circumscribed areas of full thickness epithelial loss can occur both with and without contact lens wear, however the risk of infection is greater in the presence of a lens due to its capacity to provide a vector for the entry of bacterial pathogens. While erosions in non-contact lens wearers are thought to result from defective epithelial basement membrane anchoring, the underlying causes during contact lens wear are yet unknown. This article sets out to review corneal erosions associated with contact lens wear, their associated risk factors such as extended wear, the mechanisms that may be responsible for their formation and the factors that differentiate them from other contact lens related adverse events. Appropriate diagnosis and understanding of the relevant pathophysiology is important to the effective treatment and an understanding of the aetiological factors responsible for erosions is critical to the development of preventative strategies and effective clinical care.