Contact lens complications in focus

Delegates received tips on differentiating between microbial keratitis and a corneal infiltrative event at the Specsavers Professional Advancement Conference (Birmingham International Convention Centre, 14 September).

During his presentation Confidence in contact lens complications, optometrist, David Jameson, shared that while ocular inflammation can be a sign of an infection, there are also other causes.

For example, allergies or physical irritation caused by a poor contact lens fit may also be prompting inflammation.

He explained that key questions to cover when asking about pain associated with inflammation include the location of the discomfort, whether there is a difference when the lens is removed, and the severity of the pain. Optometrists can also check if the patient is experiencing photophobia.

“These are all things that can give us clues. This really illustrates the pertinence of history and symptoms,” Jameson highlighted.

When determining whether a patient is likely to have a corneal infiltrative event or microbial keratitis, Jameson shared that pain becoming worse on lens removal should raise suspicion of microbial keratitis.

More severe pain, anterior chamber activity, mucopurulent discharge and a centrally located epithelial defect may also be associated with microbial keratitis.

However, Jameson highlighted that corneal infiltrative events are much more common than microbial keratitis.

He added that a daily soft contact lens wearer who presents to practice with an irritated eye is 75 times more likely to be experiencing a corneal infiltrative event than microbial keratitis.

Jameson outlined the most common reasons for contact lens drop out, noting that comfort or fit is the most common cause (45.6%), followed by vision (17.5%).

He noted that fear or history of eye infections is a relatively rare reason for contact lens drop out – cited by 3.5% of wearers.