Perhaps many complications with contact lenses wouldn’t become complications if patients were to pay closer attention. But since they’re so highly motivated to wear them, they often miss the signs.
The advances in designs and materials ODs and patients have seen from the contact lens (CL) industry have created a heightened awareness and buzz about contact lenses.
Patients perceive them as being healthier than in the past. They may even assume that now they can push the limits of CL wear even further, without the fear of consequences they had previously. ODs know this isn’t true, and risks are still very real.
Perhaps many complications wouldn’t become complications if patients were to pay closer attention. But because they are so highly motivated to wear their lenses, they tend to miss the signs.
Patients may tolerate and even ignore mild redness, discomfort, and blurriness. Some of this behavior might be subconscious or blatant, and some of it may not be their fault.
CL wearers tend to have less corneal sensitivity than non-wearers, so their threshold for discomfort is often much higher than a non-CL wearer. Redness without pain is then overlooked as unimportant. This causes a delay in diagnosis and treatment and reduces their chance of having a favorable outcome.
Additionally, patients don’t often associate indiscretions in their lens care and wear regime with potential complications. They don’t realize the consequences until it’s too late.
Here are details surrounding a select number of CL complications.
Contact lens-induced acute red eye (CLARE) is inflammatory. The problem with an inflammatory condition is that while ODs know it is a reaction to something, they don’t always know the underlying cause.
The patient often presents with circumlimbal injection, several small <2 mm nonstaining infiltrates, mild photophobia, and tearing, but no anterior chamber reaction.
Typical causes include: hypoxia, CL overwear (noncompliance), toxic effects from trapped tear debris, mechanical irritation from a poor-fitting lens, dehydration of the lens with extended wear, solution hypersensitivity or toxicity, or a reaction to bacterial toxins (blepharitis).
But because we often don’t know the cause, the initial course of action is to treat it, change the underlying wearing conditions, and monitor for recurrence.
In some cases, it is important to suspend lens wear immediately and initiate supportive treatments to include lubrication and mild steroids. ODs should ask patients detailed questions about past episodes and remedies they may have tried. This is often the patient who routinely dips into that leftover bottle of Tobradex (tobramycin/ dexamethasone, Alcon) from years ago.
After resolution, the lens material, fit, and solution need to be evaluated for their potential contribution to the inflammatory event. Ideally, the patient is converted to daily disposables.
Patient education is key for long-term resolution. Patients need to understand that the redness is a manifestation of unhealthy wearing conditions. It's not about fixing the red eye—it’s about changing the underlying conditions that created the red eye.
1. Chalmers, RL, Keay L, McNally J, Kern. Multicenter case-control study of the role of lens materials and care products on the development of corneal infiltrates. Optom Vis Sci. 2012 Mar;89(3):316-25.
2. Steele KR, Szczotka-Flynn L. Epidemiology of contact lens-induced infiltrates: an updated review. Clin Exp Optom. 2017 Sep;100(5):473-481.