Contact lens epithelial microcysts

Epithelial microcysts are an abnormal corneal response at the cellular level to chronic hypoxia from contact lens wear. When present, they tend to be observed in soft contact lens wearers, particularly those wearing extended-wear lenses. A hypoxic state can result in the development of microcysts due to such causes as... 

The soft contact lens patient who becomes symptomatic from epithelial microcysts tends to develop symptoms rather suddenly after uneventful contact lens wear. It is not uncommon for the patient with microcysts to have been remiss in timely follow-up care, when the formation of microcysts may have been detected before symptoms developed. Symptoms associated with this condition include burning, foreign body sensation, tearing, and photophobia, all likely related to the disrupted epithelium. Decreased visual acuity results, even with the best spectacle correction in place, because of the now irregular corneal surfece. 

Epithelial microcysts may take weeks to months to resolve, althongh the therapy described above is generally needed only for the first 1 or 2 weeks after acnte presentation. Once the patient becomes asymptomatic, it can be a challenging management issne to convince the patient that contact lens wear shonld be discontinned imtil the corneal tissue is healed. While corneal healing is being... 

Figure 26-60 Epithelial microcysts observed in diffuse illumination (A) and with NaFl staining (B) secondary to soft contact lens wear.

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