COMPLICATIONS OF CONTACT LENS WEAR

COMPLICATIONS OF CONTACT LENS WEAR


COMPLICATIONS OF CONTACT LENS WEAR

1. Intolerance: Some people find wearing contact lenses intolerable.

2. Corneal complications:

  • Corneal abrasion
  • Corneal edema
  • Corneal vascularisation
  • Microbial keratitis (Pseudomonas, Acanthamoeba)
  • Sterile corneal infiltrate.

3. Giant papillary conjunctivitis

4. Hypoxia:

  • Cornea is deprived of oxygen from the tear film by the presence of the contact lens.
  • The cornea becomes edematous & new vessels may develop in the limbal area.

5. Sensitivity:

  • May develop in response to the preservative (thiomersal) in the cleaning & soaking solution.
  • This results in allergic conjunctivitis.

OVERWEAR SYNDROME

  • Occurs when hard lenses are worn for too long.
  • Infrequent with soft contact lenses.
  • Plate-like epithelial defect (corneal abrasion) in the center of the cornea.

Symptoms

  • eye pain
  • redness
  • lacrimation
  • photophobia.

Prevention 

  • strict adherence to wearing time restriction
  • including not wearing lens during sleep.
  • important to stop wearing contact lenses.

TREATMENT

  • Initially prophylactic antibiotics & cycloplegic agents to alleviate pain.
  • Later focus on refitting the patient nto a more oxygen permeable lens material.
  • Discontinuing all contact lenses.
  • Cold compresses & systemic analgesics are helpful to relieve symptoms.

 MICROBIAL KERATITIS DUE TO CONTACT LENS

  • 15% to 50% of people using contact lenses will develop acute keratitis or corneal ulcers at some time in their lives.
  • P.aeruginosa is the etiological agent in greater than 40% of these cases.
  • Organism causing microbial keratitis in contact lens user are:
  1. Pseudomonas (most common)
  2. Acanthamoeba (2nd most common)
  3. Pneumococcus
  4. Staphylococcus
  5. Haemophillus
  6. Candida albicans
  7. Aspergillus niger

CORNEAL HYPOXIA

  • Increase in local temperature, microtraumas on the corneal epithelium.
  • Biofilm formation on the lens are the factors contributing to this problem.
  • Clinical signs & symptoms:
  1.  ocular pain, watering, photophobia
  2. conjunctival injection & grayish mucopurulant discharge.
  • Biomicroscopic examination of a patient with microbial keratitis shows a diffusely infiltrated lesion that is often central in location.
  • This infiltrate appears as white spot on the cornea.

TREATMENT

  1. Discontinuation of the contact lenses
  2. Topical antibiotics (eye drops  or ointment)
  3. Cycloplegics to give rest to the eye.

Exam Important

  • Giant papillary conjunctivitis occurs as an allergic response to Contact lens.
  • Complication of soft contact lens is Folliculosis.
  • Most common infection in contact lens users is Pseudomonas.
  • A soft contact lens users has corneal keratitis cause is Pseudomonas infection.
  • A soft contact lens wearer developed pain & itching of the eye & showed a reticular pattern on the corneal epithelium the cause could be Acanthamoeba.
  • Keratitis in contact lens wearer is caused by:
  1. Pseudomonas (most common)
  2. Acanthamoeba (2nd most common)
  3. Pneumococcus
  4. Staphylococcus
  5. Haemophillus
  6. Candida albicans
  7. Aspergillus niger
  • Corneal complications of contact lens use Acanthamoeba keratitis, Corneal infiltrate & Corneal vascularization.
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