Contact lens associated conjunctivitis

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What is conjunctivitis?

Conjunctivitis is the inflammation of the tissue conjunctiva, which lines the insides of the eyelids. It is a very common and treatable eye infection. Conjunctiva keeps the eyelid and the eyeball wet. In contact lenses, conjunctivitis is the allergic type.

What are the causes of conjunctivitis?

Conjunctivitis is caused by virus, bacteria, allergens like smoke and dust particles, or foreign bodies in the eye - typically contacts.

What are the types of conjunctivitis in contact lenses?

There are four types of contact lens induced conjunctivitis.

  • Allergic conjunctivitis
  • Atopic conjunctivitis
  • Toxic conjunctivitis
  • Vernal conjunctivitis

Allergic conjunctivitis: Allergic conjunctivitis is the most common type. In people without allergy, contacts induce allergy against preservatives in lens solutions. In people with allergy contact lenses aggravate the conditions. Allergic conjunctivitis can be seasonal caused by seasonal allergens like pollens or perennial caused by perennial allergens like smoke, dust or animal dander.

The symptoms are:

  • Redness
  • Swelling
  • Tearing
  • Itching
  • Occasional discharge

Sometimes it is difficult to diagnose allergic conjunctivitis because other disorders like dry eyes have similar symptoms. In such cases patient history and deeper eye examination helps. In allergic conjunctivitis, itching is the most severe symptom.

As in other contact lens related disorders the ideal solution would be removal of the offending lens and the solution preservative till the disorder subsides. Later they may be replaced by new lenses and a lens care regime free of preservatives. If the disorder persists gas permeable lenses may be used.

Where lens removal is not possible, artificial tears, cool compressors and ocular irrigation can provide relief. Topical non-steroid and anti-inflammatory agents may be used. Steroids are used, if at all, in more severe cases.

In pre-existing allergy cases the condition should be properly controlled before resuming lens wear.

Atopic conjunctivitis: Atopic conjunctivitis is the most severe form of allergy. People with eczema are more prone to it. It is a chronic condition and the prognosis is guarded. Atopic conjunctivitis is caused by airborne allergens and certain foods.

The symptoms are:

  • Itching
  • Dry eyes
  • Photophobia
  • Blurred vision

Atopic conjunctivitis left untreated may lead to corneal swelling and conjunctival scarring. In some rare cases, lack of early treatment has led to blindness. Atopic conjunctivitis is rare and is seen mainly in older people.

Topical steroids, mast cell stabilizers and topical antihistamines are the common medications. In severe cases oral steroids may be used for a short time.

Considering the severity of the disorder patients should be dissuaded from wearing contacts.

Toxic conjunctivitis: Toxic conjunctivitis is an allergy often caused by preservatives present in lens cleaning solutions. These preservatives are absorbed by the lenses and trigger allergic reactions in the eye. Toxic conjunctivitis occurs more in soft contact lenses since they absorb liquids more easily.

This condition is also caused by overuse of cosmetics. Traces of cosmetics often remain in the wearer’s hands due to inadequate washing and get coated on the lenses during handling, setting off allergic reactions.

The symptoms are:

  • Redness
  • Corneal abrasions
  • Fine infiltrates

Here also, for treatment, lens discontinuation is advised till the disorder subsides. In severe cases ocular lubricants or a short course of topical steroids may be used.

Vernal conjunctivitis: Vernal conjunctivitis is an allergic disorder, which occurs between the ages of 5 and 20 years. As the name suggests it is a seasonal disorder occurring during spring and fall usually in warm and dry climates. It can also be perennial. Often it becomes difficult to distinguish between these two types of vernal allergy.

The symptoms are:
  • Itching
  • Redness
  • Irritation
  • Foreign body sensation
  • Blurred vision

Diagnosis must take special care to distinguish vernal conjunctivitis from giant papillary conjunctivitis and seasonal allergic conjunctivitis. The symptoms in vernal conjunctivitis are more severe. The prognosis for this disorder is good.

Treatment may include cool compresses along with topical antihistamines, vasoconstrictors and mass cell stabilizers. Vernal conjunctivitis responds well to topical steroids which are necessary in severe cases but should be discontinued as soon as the patient starts responding to treatment. Topical mast cell stabilizers, used alongside steroids, reduce the symptoms as also the steroid dosage.

Since vernal conjunctivitis often occurs in children, steroid treatment should be limited as far as possible and the patient constantly monitored for any side effects.

The disorder usually resolves on attaining adulthood. Patients can safely resume wearing contacts once the condition is fully resolved.