Complications of contact lenses
- Karen S DeLoss, OD
Karen S DeLoss, OD
- University of Michigan Department of Ophthalmology
- H Kaz Soong, MD
H Kaz Soong, MD
- Professor of Ophthalmology and Visual Sciences
- W.K. Kellogg Eye Center
- University of Michigan Medical School
- Christopher T Hood, MD
Christopher T Hood, MD
- Clinical Assistant Professor of Ophthalmology and Visual Sciences
- University of Michigan W.K. Kellogg Eye Center
Millions of people worldwide wear contact lenses. Noninfectious and infectious complications of contact lenses are therefore common and vary in severity from clinically inconsequential to potentially vision-threatening. In a survey of contact lens wearers in the United States, nearly one-third had experienced a contact lens-related condition that required a doctor's visit .
Primary care and emergency department clinicians are often the first to evaluate patients with contact lens–related problems. Although many of these conditions necessitate referral to an eye care specialist, familiarity with these complications by the frontline clinician will allow prompt diagnosis, treatment, and appropriate triage.
The presentation and management of complications associated with contact lenses will be reviewed here. An overview of contact lenses and specific microbial infections related to contact lens wear are discussed separately. (See "Overview of contact lenses" and "Clinical manifestations and diagnosis of Fusarium infection", section on 'Keratitis' and "Free-living amebas and Prototheca", section on 'Keratitis'.)
The maintenance of a smooth and transparent anterior refractive surface is critical to good vision. A complex interplay between the corneal and conjunctival epithelium, the tear film, and the overlying eyelids provides protection against infection and scarring. Noninfectious complications are minimized with a well-fit contact lens that both rests on the pre-corneal tear film and moves only enough to allow good fluid and gas exchange, thereby functioning as a de facto extension of the ocular surface.
Dryness — Contact lens related dryness is commonly encountered and is the most frequent reason for contact lens discontinuation. Dryness can be caused by poor tear film, oxygen deprivation, lens deposits, and contact lens solution incompatibility [2-6]. Treatment includes artificial tears with and without contact lenses, topical cyclosporine 0.05%, and management of blepharitis and meibomian gland dysfunction when applicable. Patients may benefit from using lubricant eye drops before and after contact lens wear , refitting with a higher oxygen permeable lens material, or switching contact lens care solutions. (See "Blepharitis".)
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- NONINFECTIOUS COMPLICATIONS
- Sterile corneal infiltrates
- Corneal epithelial problems
- - Mechanical corneal abrasion
- Hypoxic reactions
- Toxic and/or immune reactions
- - Superior limbic keratoconjunctivitis
- Tight lens syndrome
- Dislocated contact lens
- Giant papillary conjunctivitis
- Subconjunctival hemorrhage
- Endothelial complications
- Limbal stem cell deficiency
- CONTACT LENS–RELATED INFECTIOUS KERATITIS
- Risk factors
- - Clinical diagnosis
- - Microbial culture
- - Impression cytology
- - Confocal microscopy
- - General recommendations
- - Bacterial keratitis
- - Fungal and protozoan
- SUMMARY AND RECOMMENDATIONS