The CMGs offer information on the diagnosis and management of a range of conditions that present with varying frequency in primary and first contact care.
Contact lens (CL)-associated infiltrative keratitis is inflammation of the cornea caused by immune responses to bacteria on the surface of the lens or lid margin. It is usually unilateral. Patients may experience foreign body sensation, photophobia, redness and watering. It is important to distinguish between this common, self-limiting, non-infective condition and sight-threatening microbial keratitis. This Clinical Management Guideline outlines the aetiology, signs and symptoms and evidence-based recommendations for diagnosing and managing CL-associated infiltrative keratitis. It provides recommendations for non-pharmacological management through temporary discontinuation of lens wear and education around lens hygiene and wearing schedules.
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What is contact lens (CL) associated infiltrative keratitis?
This condition, affecting contact lens wearers, has been given many different names. It is an inflammation of the cornea (the clear window of the eye) caused by a reaction to bacteria on the surface of the contact lens. Patients experience slight discomfort, redness and watering of the eye (it usually affects just one eye) and they may be unduly sensitive to light. The optometrist will see a small opaque area or areas near the edge of the cornea, plus inflammation of the white of the eye.
How is CL-associated infiltrative keratitis managed?
The most important task of the optometrist is to distinguish between this condition and an actual infection of the cornea, which is a sight-threatening emergency. Stopping contact lens wear usually allows the symptoms and most of the signs to resolve within 48 hours.
Patients will usually need to be reminded of contact lens hygiene measures, including hand washing before handling their lenses, the need to replace their lens case frequently and avoiding overnight wear of their lenses.
Keratitis, CL-associated infiltrative - 17 February 2026 The aetiology section has been revised to provide updated statistics for asymptomatic cases of contact lens associated infiltrative events (CIE). The predisposing factors section has been amended to include additional contact lens-related, and other clinical factors that are more likely to result in the development of a CIE.
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