View source for Contact lens problems

==Background==
*Contact lens wearers are at increased risk of unique ocular complications. A thorough ophthalmic exam should be performed in patients presenting with ocular complaints. <ref>The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. Philadelphia: Lippincott, 1994.</ref>
*Mechanisms of complications include<ref>https://eyewiki.aao.org/Contact_lens_complications</ref>:
**Direct trauma
**Decreased corneal oxygenation
**Reduced corneal/conjunctival wetting
**Allergic/inflammatory responses
**Infection

==Clinical Features==
*Presentation of various problems may be complicated by hypoesthesia in chronic contact lense wearers
**Pain, photophobia, foreign body sensation, decreased visual acuity, discharge, and burning are common.

==Differential Diagnosis==
''Contact lens wearers are at increased risk of:''
*Infectious corneal infiltrate or ulceration
**bacterial(pseudomonas in particular), fungal, and acanthamoeba
*Keratoconjunctivitis
*Hypersensitivity to contact lens solution
**often secondary to a new solution or inadequate lens rinsing
*Contact lens induced Giant Papillary Conjunctivitis
*[[Allergic conjunctivitis]]
*Corneal edema, distortion
*Sterile infiltrates
*Neovascularization
*Displaced contact lens
**if displaced it is usually in the superior fornix

==Evaluation==
*History
**type of contacts, duration of wear, quality of symptoms, associated vision loss, prior contact lens complications, prior ocular surgeries
*Exam
**Visual acuity with visual fields as indicated
**if photophobia is it direct or consensual? 
***Iritis/uveitis are present with consensual photobia
**Ocular Pressure
**Remove lens and perform slit lamp exam with fluorescein
***Atraumatic epithelial defect with fluorescein uptake should raise concern for ulceration
***Pseudodendrites could indicate HSV or Acanthamoeba- consult ophtho
**Invert lids
***retained Foreign body or contact lens could be present.
**Evaluate anterior chamber
***Any infectious/inflammatory cause could produce anterior cells and flare.

==Management==
*Corneal Ulceration (ulcerative keratitis)- Infiltrate + epithelial defect + Anterior chamber reaction + Pain
**< 24 hour ophtho followup
**Intensive topical Antibiotics- differing opinions but a safe option is 1-2 drops into the affected eye every 15 minutes for the first two hours and then hourly until seen by ophthalmology.
**NEVER patch a contact lens wearer for comfort as this can accelerate infection
***The provider must stress the importance of strict adherence to the dosing protocol
*Corneal Abrasion
**urgent ophtho followup
**treat aggressively as above if ulcer cannot be excluded.
**fluroquinolones (4-8 times daily) and lens removal are reasonable if uncomplicated abrasion expected. 
*hypersensitivity
**discontinue contact lens wear and prescribe preservative free drops
**routine ophtho followup
*Contact lens deposits, neovascularization, corneal warpage, Chronic epithelial changes, dry eye are all diagnoses of exclusion and should not be made definitively in the emergency department- refer to ophtho and treat aggressively if infection is suspected.

==Disposition==
*Always instruct patients to remove contact lenses until cleared by an ophthalmologist.
*if the above conditions are uncomplicated( no corneal perforation, vision loss, endophthalmitis, or other permanent visual threat) these patients may be discharged with next day ophthalmology followup.

==See Also==


==External Links==


==References==
<references/>
[[Category:Ophthalmology]]