Abstract
High Dk silicone hydrogel lenses have overcome many of the hypoxic problems associated
with traditional extended wear and the popularity of continuous wear (up to 30 nights)
with these lens types is increasing. Results from clinical trials indicate that the
typical physiological changes associated with edema from conventional extended wear
of low Dk/t lenses do not occur with continuous wear of silicone hydrogel lenses. These changes include neovascularization,
striae, microcysts and an increase in bulbar and limbal hyperemia.
It is perhaps not surprising though that a number of adverse events do still occur
with silicone hydrogel lenses when they are worn on a continuous wear basis. These
include inflammatory conditions such as contact lens-induced peripheral ulcers (CLPU),
contact lens-induced acute red eye (CLARE), infiltrative keratitis (IK) and contact
lens papillary conjunctivitis (CLPC). Other events such as superior epithelial arcuate
lesions (SEAL) and localised CLPC may be due to mechanical influences. While these
conditions are not sight threatening, they may be painful and are certainly inconvenient
to both the patient and the practitioner. It is therefore very important that the
signs and symptoms associated with these events be recognised in order that they may
be accurately identified and appropriately managed.
The purpose of this review article is to describe the pathophysiology, etiology, and
clinical presentation of these adverse events when observed with continuous wear contact
lenses and to discuss their associated risk factors and incidence. Clear management
and treatment strategies are also presented and a number of approaches to minimize
adverse events with continuous wear of silicone hydrogel contact lenses are suggested.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Contact Lens and Anterior EyeAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
Oxford Canadian dictionary, 1998.
- Hypoxic effects on the anterior eye of high-Dk soft contact lens wearers are negligible.Optom. Vis. Sci. 2001; 78: 95-99
- Severity and management of contact lens related complications with continuous wear of high-Dk silicone hydrogel lenses.Optom. Vis. Sci. 2000; 77: 216
- Microcysts: clinical significance and differential diagnosis.Optometry. 2001; 72: 452-460
- Microcyst response to high-Dk/t silicone hydrogel contact lenses.Optom. Vis. Sci. 2000; 77: 582-585
Dumbleton K, Jones L, Chalmers, et al. Clinical characterization of spherical post-lens debris associated with lotrafilcon high-Dk silicone lenses. CLAO J 2000;26;4:186–92.
- Ocular bacteriology.Rev. Med. Microbiol. 1996; 7: 123-131
- Isolation of Staphylococcus aureus from a contact lens at the time of a contact lens-induced peripheral ulcer: case report.Cornea. 2000; 19: 116-120
- Contact lens induced peripheral ulcers during hydrogel contact lens wear.CLAO J. 1998; 24: 145-151
- Gram-negative bacteria can induce contact lens related acute red eye (CLARE) responses.CLAO J. 1996; 22: 47-52
- Haemophilus influenzae adherent to contact lenses associated with production of acute ocular inflammation.J. Clin. Microbiol. 1996; 34: 2426-2431
- Incidence of contact-lens-associated microbial keratitis and its related morbidity.Lancet. 1999; 354: 181-185
- The relationship between contact lens oxygen permeability and binding of Pseudomonas aeruginosa to human corneal epithelial cells after overnight and extended wear.CLAO J. 1999; 25: 80-100
- Host-defence mechanism of the ocular surfaces.Biosci. Rep. 2001; 21: 463-480
Willcox MDP, Sankaridurg PR, Lan J, et al. Inflammation and infection and the effects of the closed eye. In: Sweeney D, editor. Silicone hydrogels. The rebirth of continuous wear contact lenses. Oxford: Butterworth–Heinemann, 2000. p. 45–75.
Weissman BA, Mondino BJ. Microbial keratitis. In: Efron N, editor. The cornea its examination in contact lens practice. Oxford: Butterworth–Heinemann, 2001. p. 50–85.
- Changes in the ocular biota with time in extended and daily wear disposable contact lens use.Infect. Immun. 1995; 63: 4501-4505
- Quantitative alterations of the commensal eye bacteria in contact lens wear.Eye. 1991; 5: 70-74
- Microbial contamination of hydrophilic contact lenses: quantitation and identification of micro-organisms associated with contact lenses while on the eye.Optom. Vis. Sci. 1993; 70: 185-191
- Potential sources of bacteria that are isolated from contact lenses during wear.Optom. Vis. Sci. 1997; 74: 1030-1038
- Diurnal tear cycle: evidence for a nocturnal inflammatory constitutive tear fluid.Invest. Ophthalmol. Vis. Sci. 1992; 33: 626-640
- Adaptive effects of 30-night wear of hyper-O2 transmissible contact lenses on bacterial binding and corneal epithelium: a 1-year clinical trial.Ophthalmology. 2002; 109: 27-39
- Contact lens-induced peripheral ulcers with extended wear of disposable hydrogel lenses: histopathologic observations on the nature and type of corneal infiltrate.Cornea. 1999; 18: 538-543
- Atypical presentation of contact lens induced peripheral ulcers—multiple focal infiltrates.Optom. Vis. Sci. 2000; 77: 164
- Inflammatory adverse event rates over 3 years with silicone hydrogel lenses.Invest. Ophthalmol. Vis. Sci. 2002; 43: 40
- Bacterial populations on 30-night extended wear silicone hydrogel lenses.CLAO J. 2001; 27: 30-34
- Microbial keratitis associated with extended wear of silicone hydrogel contact lenses.Br. J. Ophthalmol. 2002; 86: 355-357
- Contact lens related corneal infections.Biosci. Rep. 2001; 21: 445-461
- Strategies for the management of microbial keratitis.Br. J. Ophthalmol. 1995; 79: 777-786
- Antimicrobial management of presumed microbial keratitis: guidelines for treatment of central and peripheral ulcers.Br. J. Ophthalmol. 1998; 82: 137-145
- Some potential pathogenic traits of Gram-negative bacteria isolated during ocular inflammation and infections.Clin. Exp. Optom. 1998; 81: 56-62
- Differences in the pathogenesis of bacteria isolated from contact-lens-induced infiltrative conditions.Aust. N. Z. J. Ophthalmol. 1999; 27: 231-233
- Gram-negative bacteria and contact lens induced acute red eye.Indian J. Ophthalmol. 1996; 44: 29-32
- Bacterial colonization of disposable soft contact lenses is greater during corneal infiltrative events than during asymptomatic extended lens wear.J. Clin. Microbiol. 2000; 38: 4420-4424
- Haemophilus influenzae adherent to contact lenses associated with production of acute ocular inflammation.J. Clin. Microbiol. 1996; 34: 2426-2431
- A hypothesis for the aetiology of soft contact lens-induced superior arcuate keratopathy.Int. Contact Lens Clin. 1993; 20: 177-179
- Superior epithelial arcuate lesions with soft contact lens wear.Optom. Vis. Sci. 2001; 78: 9-12
- Superior epithelial arcuate lesions (SEALs): a case control study.Invest. Ophthalmol. Vis. Sci. 2000; 41: s386
- A clinical comparison of limbal and paralimbal superior epithelial arcuate lesions (SEALs) in high-Dk EW.Invest. Ophthalmol. Vis. Sci. 2001; 42: s595
- Comparison of the incidence of contact lens papillary conjunctivitis (CLPC) between 6 and 30 nights high-Dk soft extended wear schedules.Invest. Ophthalmol. Vis. Sci. 2001; 42: s597
- Factors associated with unusual cases of acute infiltrative keratitis in silicone hydrogel extended wear.Ophthalmol. Vis. Sci. 2002; 43: 125
- The clinical presentation, prevalance and risk factors of focal corneal infiltrates in soft contact lens wearers.CLAO J. 1996; 22: 30-37
- The relative risk of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses: a case–control study (Microbial Keratitis Study Group).N. Engl. J. Med. 1989; 321: 773-778
- Increased susceptibility of younger people to adverse reactions with silicone hydrogel contact lens continuous wear.Optom. Vis. Sci. 2001; 78: 229
- Non-compliance with contact lens care may increase the occurrence of adverse ocular responses.Optom. Vis. Sci. 2001; 78: 228
- A clinical look at a silicone hydrogel extended wear lens.Contact Lens Spectrum. 2002; 17: 38-41
Holden BA, Sankaridurg PR, Jalbert I. Adverse events and infections: which ones and how many? In: Sweeney D, editor. Silicone hydrogels. The rebirth of continuous wear contact lenses. Oxford: Butterworth–Heinemann, 2000. p. 150–213.
- Seven-day extended wear and 30-day continuous wear of high oxygen transmissibility soft silicone hydrogel contact lenses: a randomized 1-year study of 504 patients.CLAO J. 2001; 27: 125-136
- Extended wear: past, present and future.Contact Lens Spectrum. 2002; 17: 32-37
- The incidence of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses.N. Engl. J. Med. 1989; 321: 779-783
- The annualized incidence of contact lens induced keratitis in Sweden and its relation to lens type and wear schedule: results of a 3-month prospective study.CLAO J. 1994; 20: 225-230
Article info
Identification
Copyright
© 2002 British Contact Lens Association. Published by Elsevier Inc. All rights reserved.
