Contact lens problems
Background
- Contact lens wearers are at increased risk of unique ocular complications. A thorough ophthalmic exam should be performed in patients presenting with ocular complaints.
- Mechanisms of complications include[1]:
- Direct trauma
- Decreased corneal oxygenation
- Reduced corneal/conjunctival wetting
- Allergic/inflammatory responses
- Infection
Clinical Features
- Presentation of various problems may be complicated by hypoesthesia in chronic contact lense wearers
- Pain, photophobia, foreign body sensation, decreased visual acuity, discharge, and burning are common.
Differential Diagnosis
Contact lens wearers are at increased risk of:
- Infectious corneal infiltrate or ulceration
- bacterial(pseudomonas in particular), fungal, and acanthamoeba
- Keratoconjunctivitis
- Hypersensitivity to contact lens solution
- often secondary to a new solution or inadequate lens rinsing
- Contact lens induced Giant Papillary Conjunctivitis
- Allergic conjunctivitis
- Corneal edema, distortion
- Sterile infiltrates
- Neovascularization
- Displaced contact lens
- if displaced it is usually in the superior fornix
Evaluation
- History
- type of contacts, duration of wear, quality of symptoms, associated vision loss, prior contact lens complications, prior ocular surgeries
- Exam
- Visual acuity with visual fields as indicated
- if photophobia is it direct or consensual?
- Iritis/uveitis are present with consensual photobia
- Ocular Pressure
- Remove lens and perform slit lamp exam with fluorescein
- Atraumatic epithelial defect with fluorescein uptake should raise concern for ulceration
- Pseudodendrites could indicate HSV or Acanthamoeba- consult ophtho
- Invert lids
- retained Foreign body or contact lens could be present.
- Evaluate anterior chamber
- Any infectious/inflammatory cause could produce anterior cells and flare.