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2.11 Contact Lens Overwear and Contamination


Presentation

A patient who wears hard, impermeable contact lenses may come to the ED in the early morning complaining of severe eye pain, after he has fallen asleep with his lenses in or stayed up late, leaving his lenses in for more than 12 hours. Extended-wear soft lenses can cause a similar syndrome when left in for days or contanimated with irritants. The patient may not be able to open his eyes for examination because of pain and blepharospasm. He may show obvious corneal injury, with signs of iritis and conjunctivitis, or show no visible findings at all without fluorescein staining.

What to do:

What not to do:

Discussion

Hard contact lenses and extended-wear soft lenses left in place too long deprive the avascular corneal epithelium of oxygen and nutrients from the tear film. This produces diffuse ischemia, which usually heals perfectly in a day, but can be exquisitely painful as soon as the lenses are removed. Soft lenses can absorb chemical irritants, allergens, bacteria and ameba if they soak in a contaminated cleaning solution. There are approximately 25 million contact lens wearers in the US. Adverse reactions range from minor transient irritation to corneal ulceration and infection that may result in permanent loss of vision from corneal scarring. Pseudomonas is most commonly associated with contact lens-related keratitis. It is for this reason that the management of these cases should differ from routine care given to mechanical corneal abrasions not caused by contact lenses. Occlusive patching and corticosteroid medications favor bacterial growth and are therefore not recommended in the setting of contact lens use.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
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