Contact lenses are one of the most commonly prescribed medical devices in use worldwide today.
From children to seniors, movie sets to elementary schools, it's almost impossible to go through an entire day without encountering someone wearing lenses. Unfortunately, the convenience and frequency of contact lens wear make it easy for patients to take for granted the reality that their lenses are, in fact, medical devices and therefore, come with certain health risks.
Overwear is common and increasing as manufacturing companies produce lenses that are higher in quality and comfort. Therefore, it is the clinician's responsibility to both educate the contact lens patient on the risks involved in wearing his or her lenses and be able to recognize and manage the complications of contact lens abuse when they inevitably present in your chair.
This article will review three of the most common problems associated with contact lens overwear and how to treat those issues.
1. Corneal Ulcer
- Can be central or peripheral, though central ulcers are not uncommon
- Often caused by pseudomonas aeruginosa, which has the potential to penetrate the cornea
Common symptoms: Pain, redness, photophobia
Signs: Epithelial defect with underlying SEIs, anterior chamber inflammation possible
Treatment:
- D/C CL wear
- Antibiotic with frequent administration (example: Besivance Q1-2H)
- F/u in 1 day until marked improvement is noted
- As ulcer begins to heal, can taper down antibiotic use and incorporate topical steroid
- Consider culturing if high risk or unresponsive
For culturing tips, check out this article.
2. Giant Papillary Conjunctivitis (GPC)
- Telltale clinical sign is large papillae observed when the upper lid is everted
- Risk of developing GPC can be dependent upon wearing time per day, how long a patient has been a contact lens wearer, and patient’s sensitivity to a certain lens
Symptoms:
- Early stage: itching upon removal of lenses, mildly increased mucous production
- Moderate stage: blurring of vision after some hours of CL wear, increase in mucous, movement of CL lens upon blinking
- Advanced stage: inability to tolerate lenses, FBS/pain when wearing lenses, clouding of lens/blurred vision, mucous strands
Signs:
- Early stage: thickening of palpebral conjunctiva, hyperemia
- Moderate stage: notation of enlarged papillae, opaque appearance of conj
- Advanced stage: giant papillae present, often appear flattened
**Clinicians must evert patient’s upper lid if suspecting GPC**
Treatment:
- Moderate to severe presentation: lenses should be discontinued and a topical steroid prescribed until signs resolve; in order to maintain comfort, patient should be counseled on increased, thorough lens hygiene, and a mast cell stabilizer (commonly cromolyn sodium 4% QID) should be prescribed. Consider changing lens type if problem persists.
- Early presentation: can often be managed with increased lens hygiene and topical mast cell stabilizer (cromolyn sodium 4% QID) use; if patient still experiences discomfort, D/C CL wear and RX a topical steroid until resolved.
A great resource for this information and more detail on GPC can be found here.
3. Contact Lens Associated Red Eye (CLARE)
- A generalized diagnosis for a red eye in a contact lens wearer that does not have any other obvious clinical diagnosis
- Often due to irritation secondary to overwear; can also be indicative of lens intolerance or poor fitting lens
Symptoms:
- Patients may experience discomfort with lens wear or may be asymptomatic
- Patients note redness after wearing their lenses, particularly with increased wear time
Signs: Conjunctival injection without other ocular complications
Treatment:
- Often resolved with D/C of CL wear
- May require topical steroid use
- Patient should be counseled on proper CL wear and CL hygiene in order to prevent further recurrence
Finding the best contact lens for your patient that will provide great vision as well as long term comfort can make you a very successful contact lens clinician. However, making sure you are ready to handle the complications that come with theses devices is equally as important.
Just as a glaucoma patient must be counseled on his or her risk of blindness if non-compliant, it is our responsibility as doctors to make sure our patients understand the sight-threatening potential complications of abusing contact lenses.
Be an advocate for your patient, and don’t be afraid to refuse to fit a chronic abuser in lenses.
He or she may choose to find another eye care provider, but you'll rest easy at night knowing you didn't contribute to that patient possibly developing a blinding ulcer.
Patient education is key, but even the best educator will still encounter these conditions. Remember these clinical tips, and you'll be ready to handle these overwear patients when they present to you.
