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Using Contact Lenses - Is it That Simple?

A 25 years old girl, Pravina Shukla*, hailing from Pune, came with complaints of redness of her right eye since 5 days and difficulty in facing light with both her eyes since last 1 month. When questioned, she revealed that she is a chronic contact lens user which she recently discontinued due to this problem. She had been using monthly disposable lenses from a reputed company. Pravina admitted that she used her contact lenses for long hours at end varying from 8 hours to even 11 hours a day!

On examination, her vision with glasses in both eyes was 6/6 with some blurring on the right side. Dr Pooja Jain, the General Ophthalmologist at Advanced Eye Hospital, Navi Mumbai, examined her. On slit lamp evaluation, both her eyes showed redness of the outermost transparent layer of her eye, the conjunctiva (figure 1). The outer dome shaped layer of Pravina’s eye, the Cornea of both her eyes showed multiple coin shaped corneal infiltrates. Infiltrates are small grayish hazy areas on the cornea which are made up of cells of inflammation and proteins. The eye doctor also identified the development of tiny blood vessels in the periphery (figure 2 and 3).

 

               

         Figure 1: Eye Redness                                                 Figures 2 & 3: Infiltrates on Slit Lamp Examination

 

Pravina was diagnosed to have CLARE (Contact lens associated red eye) and advised to abstain from contact lenses for the next 3 weeks. She was started on an antibiotic steroid combination eye drop 4 times a day with frequent lubricating drops. Pravina recovered completely symptomatically within a week and corneal infiltrates also resolved within a month to leave very few partial opacities.

Patients who overwear their soft contacts or sleep in lenses that are not intended for overnight wear may awake early in the morning with symptoms of pain, sensitivity to light and redness. Infiltrates (small grayish hazy areas on the cornea) are usually observed in and below the epithelial layer of the cornea. The cause of CLARE is not completely understood, but several causes have been implicated; these include deficiency of oxygen, toxic effects from the waste matter trapped between the contact lens and eye surface, mechanical irritation, lack of moisture and oxygen that reaches the cornea during closed eyes, hypersensitivity to the solution and an immune response to the bacterial toxins.

Continuous wear of contact lenses may impact the metabolism and wholeness of the cornea. Overnight wear results in reduction in oxygen and excess carbon dioxide in the cornea. This may lead to excess toxin accumulation in the substance of the cornea which results in corneal swelling.

Take Home Message

  1. Overnight wear of soft contact lenses is absolutely prohibited
  2. Treatment of CLARE is aimed at minimizing patient discomfort, recovery of normal function and patient education to prevent future occurrence.
  3. Timely consultation at the sight of slightest discomfort can save your eye.
  4. Clean contacts by rubbing it gently with your index finger in the palm of your other hand. Most multipurpose solutions don’t have “No Rub” on their labels anymore. Lightly rubbing your contacts removes surface buildup.
  5. Clean your contact lens case every time you use it with either sterile solution or hot tap water. Let it air dry. Replace the contact lens storage case every three months.

About Advanced Eye Hospital and Institute:

Advanced Eye Hospital and Institute (AEHI), Sanpada, has one of the best eye doctors in Navi Mumbai who are trained from the best of the Institutes of India and Abroad. This case study for Contact lens users tells us about the harmful effects of using contact lens for long hours and how it causes Contact lens associated red eyes. It further notifies us about the precautions for contact lens wearers. Hence, it is important to undergo a detailed eye check-up from the best eye specialist.