Contact Lens Related Problem Solving
Contact Lens Related Problems
Contact lenses, though worn by millions, may result in many potential complications. Most of these problems can be attributed to contact lens over-wear, poor lens hygiene, sensitivity to lens materials or solutions, or a poor fit.
Swimming with contact lenses in may be associated with a devastating ocular infection known as Acanthamoeba keratitis.
Giant Papillary Conjunctivitis
Development of red, itchy eyes, and in some cases, poor vision with contact lens wear may sometimes be associated with a condition known as giant papillary conjunctivitis. This condition can only be diagnosed by eversion of the upper eyelid, demonstrating the giant papillae characteristic of this condition. The cause of the condition is thought to be an immune reaction to the material of, or the presence of, the contact lens itself. Treatment generally requires discontinuance of, or limitation of, contact lens wear. In most cases, the temporary use of steroids or the long-term use of mast cell stabilizing agents will control giant papillary conjunctivitis.
One of the most dreaded complications of contact lens wear is corneal ulceration. This is a bacterial infection of the cornea, which is nearly always bacterial in origin. The condition usually presents with a red, painful eye with discharge, and perhaps poor or reduced vision. The patient may occasionally observe a white spot on the cornea of the involved eye. If the diagnosis of corneal ulceration is confirmed, Dr. J. D. Miller, Jr. may or may not take a culture, and antibiotic eye-drops are then administered. The patient is usually followed daily until the condition resolves. Permanent visual loss occurs in some patients despite early therapy, depending mostly on what part of the cornea (central or peripheral) is most affected.
Contact Lens Solution Hypersensitivity
Hypersensitivity to contact lens solutions may also occur. These patients usually present with red, irritated eyes and difficulty wearing the contact lenses. Usually the patient has recently changed contact lens cleaning or storage solutions. Use of preservative-free solutions or a solution with a different preservative may be all that is necessary to correct the problem.
Contact Lens Protein Deposits
Contact lens protein deposits may make a once comfortable contact lens very uncomfortable and irritating. The condition can usually be seen by Dr. Miller at the slit lamp examination with the lenses in. In most cases, a new lens is required to solve the problem. Enzymatic cleaning of lenses or planned-replacement contact lenses, which are disposed of regularly, may be the best options.
Tight Contact Lens Syndrome
Tight contact lens syndrome occurs when a contact lens is ill-fitting. Because of a variety of factors, including tear film deficiencies and changes in corneal curvature with contact lens wear, a tight contact lens syndrome may occur even in patients with initially well-fitting contacts. The patient usually complains that the lens feels fine until after a few hours of wear, at which point it becomes uncomfortable. The eye may also become red. The symptoms usually resolve within a few hours after discontinuance of contact lens wear.
Tight contact lens syndrome can often be diagnosed by Dr. J. D. Miller, Jr. with the pertinent history and examination, the latter of which shows a contact lens that scarcely moves on the cornea with blinking. Resolution of the problem entails fitting a contact lens with a flatter base-curve or smaller diameter. In essence, the lens must fit more loosely on the eye, allowing the tear film better access to the cornea beneath the contact lens.
Corneal warpage is a condition that may develop with hard, rigid gas-permeable, or soft contact lenses. The condition is characterized by an unusual change in the curvature of the cornea with contact lens wear. The cornea is literally “molded” by the contact lens into a distorted shape. The condition usually presents with gradual worsening of vision while wearing contact lenses, need for frequent lens power changes, and in some cases, an irritated, red eye. The condition can only be diagnosed with use of a corneal topographer, both of which determine the shape of the cornea. The only available treatment is discontinuance of contact lens wear until the cornea stabilizes (usually a few weeks or months). Contact lenses may be refit once the cornea is stable; however, recurrence of corneal warpage is likely. The patient is usually informed that glasses or, perhaps, refractive surgery may be better options depending on the degree of refractive error.