Contact Lens Deposition Part 2
SUSAN J. GROMACKI, OD, MS, FAAO
Discomfort is a well-documented reason for contact
lens discontinuation. Contact lens deposition is a primary etiology for this discomfort.
We must learn to recognize the different types of
contact lens deposits and how to manage them if we want to maximize comfort
and as a result, contact lens success for our patients. In Part 1 of this
ser- ies, I discussed protein, lipid and microorganism deposition. Following are
three more types of deposits that can affect comfortable contact lens wear.
1. Lens calculi (jelly bumps).
Also known as jelly bumps or mulberry spots, these raised circular
bumps penetrate the front surface of the contact lens (Figure 1). Composed of lipid,
protein and calcium, they result from improper lens handling and care. They're more
common with high-water-content or extended wear lenses and in patients who have
high fat, protein and alcohol intake; low tear potassium; dry eye; or incomplete
blinking. The upper eyelid may be irritated by the deposit or grab onto it, causing
the lens to decenter. Because removal would result in pits in the front lens surface,
the contact lenses need to be replaced.
it's important to re-educate the patient on proper contact lens care. It can be
valuable to demonstrate to the patient using a biomicroscope under high magnification
and illumination the appearance of his deposited lenses. You may also consider
refitting at-risk patients into lower-
water-content or GP lenses.
Because I primarily prescribe soft contact lenses in a disposable
modality, the incidence of these deposits in my practice is much less than it used
to be. I still keep a special watch, however, for jelly bumps in the conventional
lenses that I do fit, such as prosthetic opaque contact lenses.
2. Rust spot. (Courtesy of Dr. Ron Watanabe)
Appearing as small orange or red circular spots (Figure 2), you
can find these on new lenses. They are, however, highly associated with tap water
use. As a result, it's important to provide documentation and thorough patient education.
Another etiology can be a metallic particle from the environment.
In this case, perform a thorough slit lamp examination to rule out the presence
of a metallic foreign body in the eye. Most often, the rust spot itself causes no
discomfort to the patient and lens replacement isn't necessary.
Cosmetics include makeup, mascara, after-shave lotion, soap or
suntan lotion. They adhere readily to soft contact lenses, appearing iridescent,
filmy or greasy. Over time, their accumulation can cause discomfort and decrease
visual acuity. To avoid contamination, instruct patients to apply their lenses prior
to applying cosmetics. In addition, advise patients to take out their contact lenses
before removing their makeup.
Dr. Gromacki has served
as a faculty member at the University of Michigan Department of Ophthalmology
and Visual Sciences.
Contact Lens Spectrum, Issue: April 2006