Patient has eye problems due to overuse of contact lenses for months
“If in doubt, take them out.” This phrase should appear on at least three notice boards in every county in America.
You can see where this is heading …
I had a bit of an interval in the middle of a busy afternoon when a patient – who was new to us – walked in with red eyes. She was a 47-year-old African-American woman who wore contact lenses and had suffered from contact lens intolerance, redness, burning and sensitivity to light in her right eye for about three weeks.
Her medical history was remarkable for systemic hypertension lasting several years for which she was taking an angiotensin converting enzyme (ACE) inhibitor. She did not report any known drug allergy.
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She reported a history of “eye problems” in both eyes for several years and that she wore her soft contact lenses continuously for a month or two before removing them. She had no idea how old her current contact lenses were.
Examination of patients
The visual acuity (VA) captured by his usual soft contact lenses was 20 / 25-1 in the right eye and 20 / 20-1 in the left. Pupillary function was unremarkable for each eye. Examination of the anterior segment of his left eye was unremarkable except for seven old stromal scars. Two were near his visual axis. The anterior segment of his right eye was notable for the grade 1+ injection of his bulbar conjunctiva.
Her cornea was notable for diffuse superficial punctate keratopathy (SPK) affecting her central cornea and some fluorescein staining around her limbus (see Figure 1). There was no active ulceration. There were five old, inactive stromal scars. Intraocular pressure (IOP) by rebound tonometry was 19 mmHg in the right eye and 18 mmHg in the left eye.
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At this point, I explained to the patient that wearing her contact lenses excessively was the cause of the inflammation and the signs and symptoms that resulted from it. I advised her to throw away her current contact lenses and only wear glasses at least while I was treating her.
She then informed me that she did not have glasses and that she had not had them for a year or two. I asked her if she could get away with just touching her left eye (the unaffected one). She said she had tried this before and couldn’t take it because of the headache.
I asked her what the powers of her contact lenses were, and she didn’t know. So I placed it behind the phoroptera, performed a rapid dry retinoscopy, and refracted it at -3.50 SD in the right eye and -4.00 SD in the left.
I gave her a copy of her prescription and advised her to go to an optician in town who had same day service for new prescriptions for glasses and get some that day. I also gave her a sample of a topical fluoroquinolone to use every two hours while she was awake and invited her to come back the next day to recheck her eyes.
The next day she returned. She had not bought glasses and did not wear contact lenses.
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She said her eye has felt much better since the drops started. Incoming unaided VAs were 20/200 in each eye. Behind the phoropter they were 20 / 20-1 in each eye. Pupillary function was again unremarkable and the IOP was 16 mmHg in the right eye and 18 mmHg in the left eye. The bulbar conjunctival injection into his right eye was now a trace. His SPK in the central cornea was resolved and his limbal staining greatly improved.
At this point, I asked her to continue her drops every two hours while she was awake in her right eye and invited her to come back in two days for another follow-up appointment. I haven’t seen or heard from her since.
My long-term interim plan for this patient would be to bring her eyes back to baseline and then explain to her that it would be best to go ahead with glasses.
If she insisted on wearing contact lenses, I would beg her to wear nothing except daily disposables and wear them as directed.
The eyes can be relatively simple from time to time. The patients they belong to may be another story.