Cornea
Contact Lens Peripheral Ulcer
Also known as: CLPU, contact lens peripheral ulcer, CL peripheral ulcer, contact lens infiltrate, peripheral corneal infiltrate contact lens, sterile corneal infiltrate CL, CL ulcer, contact lens keratitis peripheral
Filed as: Soon
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
A sterile inflammatory corneal infiltrate at the peripheral or paracentral cornea associated with contact lens wear. Caused by an immune response to bacterial toxins (typically Staphylococci or Gram-negative organisms) or inflammatory mediators, rather than true infection. Distinct from microbial keratitis: CLPU infiltrates are typically small (< 1mm), peripheral, with minimal or no staining, and occur with lens wear — not a true corneal infection.
Recognition
Symptoms: what patients report
- Unilateral eye pain, mild to moderate.
- Redness.
- Foreign-body sensation.
- Photophobia — variable.
- Onset typically during or after contact lens wear.
- History of extended or overnight contact lens wear.
- Previous similar episodes.
Signs: what the examination shows
- Peripheral or paracentral corneal infiltrate: grey-white opacity, typically < 1mm diameter, well-defined.
- Overlying epithelial defect may be present (small, if any).
- Minimal staining with fluorescein — or no staining if epithelium is intact.
- Minimal injection overall, sometimes most prominent adjacent to the infiltrate.
- Limbal injection adjacent to the infiltrate.
- Anterior chamber: quiet or minimal reaction.
- No significant discharge.
- Multiple CLPUs in different quadrants may occur simultaneously.
What OptoGuide™ covers for contact lens peripheral ulcer
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Keratitis, CL-associated infiltrative — College of Optometrists CMG
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Infectious Keratitis in 2021. Durand ML, Barshak MB, Chodosh J. JAMA. 2021;326(13):1319-1320.
- Eye Infections. Durand ML, Barshak MB, Sobrin L. The New England Journal of Medicine. 2023;389(25):2363-2375.
- Differentiation of acanthamoeba keratitis from other non-acanthamoeba keratitis: Risk factors and clinical features. Alreshidi SO, Vargas JM, Ahmad K, et al. PloS One. 2024;19(3):e0299492.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.