is a 21-year-old female with a history of successful soft contact
lens wear since age 15. She presented with complaints of gradually
worsening mild redness and burning, OS>OD, for the last four months,
for the last four months. Her symptoms were worse in the morning and
late in the day. She denied itching, pain or discharge. Slit lamp
evaluation revealed a generalized 1+ conjunctival injection with
diffuse fine corneal staining and associated mild ciliary injection
Figure 1. Ocular surface toxicity; note
current lens type is a biweekly HEMA toric hydrogel. She uses the
Clear Care (CIBA Vision) peroxide system as her daily disinfectant.
She further reported using get the red out drops. Specifically, she
was using Visine LR (Pfizer) eye drops two to three times a day with
the starting date roughly coincident with her onset of symptoms.
presumptive diagnosis was ocular surface toxicity. We instructed her
to discontinue contact lens wear and other eye drops and to use only
preservative-free artificial tears. She was to use nothing else in
her eyes and she was scheduled for follow up in one week.
re-examined VN one week later and noted marked subjective
improvement. Her ocular surface had cleared except for some residual
redness. She returned to lens wear with new lenses and the same care
system. Her eyes were clear without inflammation at the one month
example illustrates how simply and innocently a contact lens wearer
may use a product not intended for use with contact lenses that
results in an inflammatory reaction. This is a problem with
preserved artificial tears as well. The difference here is the
vasodilatation as a rebound effect of chronic vasoconstrictor use.
Visine LR product label revealed the active ingredient to be
Oxymetazoline HCL 0.025% with inactive ingredients listed as
benzalkonium chloride, boric acid, edetate disodium, purified water,
sodium borate and sodium chloride. This product is not labeled for
use with contact lenses.
this and similar products have warning labels against use with
contact lenses, lens wearers seldom read them. The two ingredients
most likely to cause an adverse effect are Oxymetazoline and
benzalkonium chloride (BAK).
Oxymetazoline HCL is an α-adrenergic agonist that causes potent
vasoconstriction and is a long-acting ocular decongestant. Ocular
decongestant effectiveness tends to decrease over time, which may
encourage its overuse.
to and is concentrated in soft lens polymers; later release onto the
ocular surface causes a toxic event. BAK interferes with cellular
mitosis, slows epithelial healing and can cause a toxic keratitis
when used over hydrogel lenses. Cytotoxicity is dose-related;
greater doses result in greater toxicity. All BAK-preserved eye
drops are contraindicated with soft contact lens wear.
Caution Your Patients
should regularly question your patients regarding their lens care
practices and caution them not to deviate from your instructions or
change brands without first checking with your office.