conjunctivitis due to contact lens wear

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The tissue that lines the inside of the eyelid is called the conjunctiva. The conjunctiva is responsible for keeping the eyelid and eyeball moist. Inflammation of this tissue is called conjunctivitis. Bacteria or viruses, allergens, or a foreign object in the eye, i.e. contact lenses, may cause conjunctivitis.

There are four main types of conjunctivitis

  • Allergic
  • Atopic
  • Toxic
  • Vernal

Allergic conjunctivitis is the most common form. It is often seasonal, as allergies are seasonal. In the case of contact lens use, it can become more severe if allergens become trapped. Contact lens wearers with no known allergies may still experience this type of conjunctivitis, as they are occasionally allergic to contact lens solutions.

Symptoms of allergic conjunctivitis include redness, swelling, tearing, itching, and occasional discharge. Differential diagnosis is important in this case, as the symptoms are similar to other disorders. Treatment includes lens removal, artificial tears, cool compresses and irrigation. Topical agents may be used.

Atopic conjunctivitis is chronic allergic conjunctivitis. Prognosis in this case is guarded. Symptoms include itching, dry eyes, blurred vision and photophobia. Left untreated, conjunctivae scarring, corneal swelling and even blindness can occur. Treatment includes topical steroids and antihistamines, as well as mass cell stabilizers. In severe cases oral steroids may be used. Most patients do not return to contact lens use.

Toxic conjunctivitis is a reaction to contact lens solutions. Preservatives are absorbed by the lenses and cause a reaction. It occurs primarily with soft contact lenses. Toxic conjunctivitis can also be caused by cosmetics that get trapped on the contact lens.

Symptoms of toxic conjunctivitis include redness, corneal abrasions and infiltrates. Contact lens use must be discontinued until symptoms resolve. Lubricants and topical steroids may be applied.

Vernal conjunctivitis usually occurs between the ages of 5-20. It is a seasonal disorder occurring in the spring and fall, in warm dry climates. Symptoms include redness, irritation, itching, blurred vision and foreign body sensation. Differential diagnosis must be made as giant papillary conjunctivitis has similar symptoms. Treatment includes cool compresses in conjunctivitis with antihistamines, vasoconstrictors, and mass cell stabilizers. Topical steroids are used when necessary.

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