Contact lens wear

C. Complications of Contact Lens Wear and the Need for Care Products... 

VHL Lee, DJ Schanzlin, RE Smith. (1986). Interaction of rabbit conjunctival mucin with tear protein and peptide analogs. In FJ Holly, ed. The Preocular Tear Film in Health, Disease, and Contact Lens Wear. Lubbock, TX Dry Eye Institute, pp 341-355. 

Q66 Drugs that may have on adverse effect on contact lens wear include ... 

Ophtalmia neonatorum by N. gonorrhoeae and Chlamydia trachomatis is acquired during delivery. Contact lens wear predisposes to corneal infections, mostly by Pseudomonas sp. and the ameba Acan-thamoeba and Naegleria. Immunocompromised hosts are predisposed to severe retinitis by CMV and to other intra-ocular eye infections by opportunistic pathogens. 

Clinicians should ask about past and current eye disease as well as past ocular trauma. Practitioners should inquire about a history of contact lens wear. Many topically applied medications can cause corneal complications when used in the presence of soft contact lenses. Obtaining a history of current ocular medications is essential. If their continued use is necessary, the old and... 

Strabismus or amblyopia Contact lens wear Current ocular medications Eye surgery... 

Bartlett JD. Medications and contact lens wear. In Silbert J, ed. Anterior segment complications of contact lens wear, ed. 2. Boston Butterworth-Heinemann, 2000. 

Acanthamoeba keratitis is known to be difficult to diagnosis and to treat. Most patients are initially treated fiar viral, fungal, of bacterial keratitis before the diagnosis of Acanthamoeba. Most Acanthamoeba infections are associated with contact lens wear (85% to 92%), but a smaller number are secondary to trauma. The incidence of Acanthamoeba keratitis may be greater than 1 per 30,000 contact lens wearers per year as indicated by cohort studies and questionnaires. The frequency oi Acanthamoeba keratitis in contact lens wearer may be 1 per 10,000/year or higher. 

Topical ocular steroid administration also may cause the development of cataracts in both children and adults. Use of topical steroids for several years to eliminate redness associated with contact lens wear resulted in PSC formation as well as glaucoma and visual field loss. The opacities associated with steroid administration resemble those produced by ionizing radiation and ocular disease such as uveitis, retinitis pigmentosa, and retinal detachment. They differ from opacities associated with diabetes and trauma but are indistinguishable from lens changes associated with posterior subcapsular age-related cataract. 

Because rose bengal also stains skin, clothing, and contact lenses, contact with these entities should be avoided. Wearers of soft contact lenses should perform a thorough irrigation of the ocular surfece and fornices before resinning contact lens wear. Irrigation after dry eye evaluation may be helpful to some patients. 

In contact lens wear it has become apparent that conjunctival staining in general is related to symptoms of irritation and that lissamine green in particular may be more specific compared with fluorescein for those with symptoms. 

Ideally, resmnption of contact lens wear should be delayed fitr at least 60 minutes after appUcation of the anesthetic. 

To evaluate the eye s normal physiologic responses to contact lens wear, contact lenses should be fitted without topical anesthesia. However, certain limited circumstances may justify the use of topical anesthetics in contact lens evaluations.Topical anesthesia allows a rigid lens to be easily placed on the cornea and readily tolerated by the patient during the initial diagnostic evalua-tion.Topical anesthesia may also be used in fitting infants and very yoimg children with rigid contact lenses. 

Sudoriferous cysts are small, roimd, translucent, elevated masses caused by blockage of the ducts of Moll s glands. One or more lesions, tanging from 2 to 4 mm in diameter, may be observed on the anterior eyelid margin.The cysts are painless but can occasionally cause irritation or interfere with successful contact lens wear. They are filled with clear watery fluid (Figure 23-23). 

Follow-up far patients with bullous keratopathy varies depending on therapeutic contact lens wear and the severity of the disease. Most patients should be monitored every 1 to 6 months. 

Patients with CIE complain of pain, tearing, foreign body sensation, and photophobia. When asked, they often report a history of soft contact lens wear or staphylococcal lid disease. CIE is common in adults but is quite rare in children. 

Corneal ulcers are bimodal in occurrence, with the highest incidence in patients in their twenties and those in their sixties to seventies. This pattern can be attributed to the increased incidence of trauma and contact lens wear in the younger group and to ocular surfece disease and eyelid disease in the older group. 

It is also important to differentiate a red eye associated with contact lens wear from other potential causes. The definitive diagnosis can pose a clinical challenge with respect to excluding other conditions that cause an acute red eye with corneal infiltration. EKC, chlamydial keratoconjunctivitis, marginal infiltrative keratitis,... 

Adapted from Sweeney DF, Jalbert I, Convey M, et al. Clinical characterization of corneal infiltrative events observed with soft contact lens wear. Cornea 2003 22 435-442. 

Any infiltrative event necessitates discontinuation of contact lens wear. With significant corneal involvement and an anterior chamber reaction, cycloplegia with a long-acting agent such as 5% homatropine enhances patient comfort and helps to relieve iris congestion. 

Once contact lens wear is discontinued, mild infiltrative events are self-limiting over a few days to a week. The infiltrates take longer to resolve than the associated... 

Figure 26-54 (A-C) Corneal neovascularization secondary to contact lens wear. (Photos A and B courtesy of Pat Caroline photo C courtesy of Dr. Tammy Than.)...

Figure 26-55 Giant papillary conjunctivitis secondary to rigid gas-permeable contact lens wear. (Courtesy of Pat Caroline.)...

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. 

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