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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.
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