Severe keratomalacia after 12 months of continuous hydrogel contact lens wear in a psychiatric patient

• A case of keratomalacia and extreme contact lens abuse is reported.
• A psychiatric patient had been wearing hydrogel lens without removal for 12 months.
• The synergistic effect of soft contact lens abuse and vitamin A deficiency is reported.

A 53-year-old cachectic patient diagnosed with major depressive disorder was referred to our department for evaluation of a visible deformation of the right eye. She had been wearing hydrogel contact lenses on a continuous basis without removal for the last 12 months, influenced by low self-esteem and social isolation. Slit-lamp examination of the right eye showed a conical cornea, extensive neovascularization, severe stromal melting with descemetocele formation and forward bulging of the iris. Examination of the left eye revealed multiple corneal opacities, deep stromal neovascularization and anterior chamber inflammation. No sign of infection was present. Vitamin A deficiency was suspected and later confirmed. The patient required evisceration of the right eye and psychiatric treatment. Inflammatory signs of the left eye resolved within 1 week of initiating treatment. This case illustrates the synergistic effect of soft contact lens abuse and vitamin A deficiency in a psychiatric patient, and emphasizes the importance of instructing vulnerable patients on appropriate lens use and care.