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Problems with Contact Lenses
These problems occur either withpoorly seated rigid contact lensesthat rub on the surface of the cornea or from overwearing soft contact lenses.
If contact lenses are worn for extended periods of time despite symptoms, severe inflammation, corneal ulceration, and vascularization of the corneal periphery may result.
Patients find the contact lenses increasingly uncomfortable andnotice worsening of their vision. These symptoms are especially pronounced after removing the contact lenses as the lenses mask the defect in the corneal epithelium.
The ophthalmologist will detect typical cornealchanges after applying fluorescein dye (Fig. 5.11e). Keratoconjunctivitis on the superior limbus with formation of giant papillae, wart-like protrusions of connective tissue frequently observed on the superior tarsus (Fig. 5.12), are signs of contact lens or preservative incompatibility.
The patient should temporarily discontinue wearing the contactlenses, and inflammatory changes should be controlled with steroids until the irritation of the eye has abated.
Protracted therapy with topical steroids should be monitored regularly by an ophthalmologist as superficial epithelial defects heal poorly under steroid therapy. Protracted high-dosage steroid therapy causes a secondary increase in intraocular pressure and cataract in one-third of all patients.
The specific ophthalmologic findings will determine whether the patient should be advised to permanently discontinue wearing contact lenses or whether changing contact lenses and cleaning agents will be sufficient.
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