contact lens case reports
Patient GS is a 23-year-old male with
a four-year history of uneventful soft contact lens wear. He presented to our clinic
with symptoms of foreign body sensation OS, burning, itching, mild photophobia
and overall lens intolerance. He was compliant with his two-week planned replacement
lens schedule, and his lens care regimen consisted of nightly disinfection with
a multipurpose lens disinfection system. He denied the use of any other lens care
products or supplemental lubricating drops.
1. GS's left eye with mild bulbar injection.
Figure 2. Location and extent of the
Figure 3. Elevated nodules just anterior
to the neovascularization.
Slit lamp examination of the
symptomatic left eye showed mild superior bulbar inflammation as well as significant
superior neovascularization with lipid leakage (Figures 1 and 2). The superior corneal
epithelium was irregular with small, elevated gelatinous nodules adjacent to the
areas of neovascularization (Figure 3). We also noted significant punctuate staining
confined to the
superior one-third of the cornea.
Bilateral vs. Unilateral
The etiology of a bilateral
adverse event is often easy to explain. It may relate to an underlying problem such
as dry eyes, allergies or a solution sensitivity. Or it may be secondary to a lens
material and/or design limitation resulting in hypoxia or an improper lens fit.
More often than not, these anomalies present bilaterally and may or may not be symmetric.
However, when a non-infectious,
adverse event is completely unilateral, determining the cause of the condition and
providing the correct diagnosis becomes significantly more difficult.
Treating Unilateral Conditions
In recent years, the eyecare
community has identified a number of contact lens-related conditions that can result
in significant superior conjunctival and/or corneal involvement, including lens-induced
superior limbic keratoconjunctivitis, advancing wave-like epitheliopathy and lens-induced
epithelial dysplasia. While some experts suggest more invasive treatments such as
silver nitrate or conjunctival scraping or resection, we've found that it's best
to discontinue lens wear completely and prepare the patient for a three- to
six-month course of preservative-free lens lubricants. This simple therapy is
slow, yet has proven successful in managing many superior limbal complications
of obscure etiology.
is an associate professor of optometry at Pacific University and is an assistant
professor of ophthalmology at the Oregon Health Sciences University. He is also
a consultant to Paragon Vision Sciences and SynergEyes, Inc. Mark André is
director of contact lens services at the Oregon Health Sciences University and serves
as an assistant professor of optometry at Pacific University. He is also a consultant
for Alcon Labs, CooperVision and SynergEyes, Inc.
Contact Lens Spectrum, Issue: July 2005