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Focus On: Corneal Ulcer from Contact Lens Wear


A 27 year old patient comes in to the clinic complaining of pain, watering and sensitivity to light in his left eye. He is a contact lens wearer and admits he does not take the best care of his contacts.


When asked if he sleeps in his contacts the patient responds no. However....


Findings:

Vision:

Right Eye: 20/20

Left Eye: 20/60


Slit Lamp Microscopy (Big Microscope!)


Right Eye:


Normal Cornea - there are no areas of ulceration. (Source: https://drmalcolmmckellar.co.nz/eye-conditions/corneal-disease/)

Left Eye:


Notice how red the conjunctiva (white part) of the eye is along with the ulcer on the left part of the eye. Source (https://www.eyecenters.com/cornea-and-conjunctiva-louisville/corneal-ulcer/)

Diagnosis:

Left Corneal Ulcer secondary to contact lens overwear


Treatment:

Discontinue all contact lens use

Start on an antibiotic immediately

Follow up with doctor 48-72 hours

Review proper contact lens wear & care!

Consider changing to a different contact lens modality (i.e. dailies)

Consider changing to a different kind of contact lens solution


What is a Corneal Ulcer?


The cornea is the clear front part of the eye that is just in front of the iris (coloured part of the eye). The cornea is clear so it can refract (bend) light to enter the pupil (black part of the eye) and focus it on the retina. If there are an abnormalities (swelling, ulcers) then the cornea cannot focus light properly - leading to blurred vision.


Where the cornea is located & the layers it is comprised of. (Source: https://www.allaboutvision.com/resources/cornea.htm)

Ulcers & Contact Lens Wear

Contact lens wearers are at an increased risk of developing a corneal ulcer. Extended contact lens wear, improper cleaning methods, dirty cases or storing contacts in water can lead to irregularities or breaks in the surface of the cornea. Once this happens bacteria can invade and cause an ulceration. Contacts that have been deemed appropriate for overnight wear can increase the risk of infectious ulceration 15X compared to other types of wear(1).


In severe cases a corneal ulcer can lead to permanent blindness and scarring. If you have ever thought of LASIK surgery, one corneal ulcer can impair your chances of being a candidate!


Prevention


DO:

  • Change your lenses as directed by your doctor (daily/biweekly/monthly)

  • Change your storage case every 3 months

  • Use appropriate solution for your type of contacts (yes! this matters!)

  • Wash your hands before inserting and removing contacts

  • See your eye doctor if you are having any problems or continual discomfort with your contact lenses


DON'T

  • Use water to store your contacts in - this increases your risk of a serious infection caused by the bacteria Acanthamoeba (scary news story here)

  • Sleep in your contacts - even if the package says it's OK (Did you read the 15X increased risk part above??)

  • Continue to wear your contacts if they feel uncomfortable or your eye is red

  • Share your contacts (Sharing is NOT caring in this instance)

  • Please don't store your contacts in saliva - if you have done this, switch to a daily wear contact lens

Sources:

1. Kaiser, Peter K., author. The Massachusetts Eye and Ear Infirmary Illustrated Manual of

Ophthalmology. Philadelphia :Saunders, 2014. Print




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