SLK - Treatment: Which is a key management step?

• A. Continue contact lens wear with no changes.
• B. Discontinue contact lens wear until resolution, with frequent PFATs and Loteprednol 0.5% QID for 1 week.
• C. Start antiviral therapy.
• D. Proceed with refractive surgery.

Answer: (B)

Treating this condition centers on stopping the source of irritation and calming the inflammation. Discontinuing contact lens wear removes the continual mechanical friction and hypoxic stress at the superior limbus, which is driving the inflammatory process. Pairing frequent preservative-free artificial tears with a short course of a mild topical corticosteroid helps restore the surface, reduce inflammation quickly, and promote healing. A brief steroid course, such as four times daily for about a week, is used to control the inflammatory response without long-term steroid exposure. Starting antiviral therapy isn’t appropriate here because this isn’t a viral keratitis, and proceeding with refractive surgery isn’t safe while inflammation is active.