Multipurpose Non-Keratitis

BY ROBERT CAMPBELL, M.D. & PATRICK CAROLINE, C.O.T., F.A.A.O.
MAR. 1997

Sensitivities to contact lens care products have many manifestations, such as diffuse punctate keratitis, conjunctival injection, subepithelial infiltrates, pseudodendritis and superior limbic keratoconjunctivitis.

Modern chemical disinfection systems rarely cause this type of tissue disruption. More frequently, patients reacting to multipurpose lens care regimens present with completely normal external findings. Yet, many complain of only one symptom, ocular dryness. This chemically induced symptom is frequently overlooked or misdiagnosed as keratoconjunctivitis sicca.

Delayed sensitivity to a multipurpose care regimen is commonly referred to as multipurpose non-keratitis due to its lack of positive slit lamp findings. The condition may represent one of the leading causes of patient dissatisfaction with soft contact lenses today (Table 1).

GRADUAL DECREASE IN
WEARING TIME

This 27-year-old woman has worn spherical soft contact lenses for eight years. Over the past three years, she has replaced her lenses quarterly and disinfected them nightly in a multipurpose solution.

For three months, the patient had been experiencing symptoms of ocular dryness which were not resolved with preservative-free artificial tears. Her wearing time had slowly decreased from 15 hours to eight hours a day. At the time of the examination, visual acuity with the contact lenses was 20/20 OU, and her present lenses were three weeks old. Slit lamp examination was unremarkable, with no conjunctival injection, normal tear film meniscus height and no corneal or conjunctival staining with fluorescein or rose bengal (Fig. 1).

FIG. 1: MULTIPURPOSE SOLUTION REACTION WITH NO POSITIVE SLIT LAMP FINDINGS.

We diagnosed possible multipurpose solution sensitivity and instructed the patient to continue with the same lenses, but to switch to a preservative-free, hydrogen peroxide care regimen.

Five days after beginning the preservative-free care regimen, the patient reported a dramatic improvement in her dry eye symptoms. Over the next week, her wearing time returned to 15 hours a day.

DELAYED REACTION MAY CAUSE MISDIAGNOSIS

Solution sensitivities can occur at any time during a patient's contact lens wearing history. When the reaction is delayed, the cause is frequently overlooked or misdiagnosed. This is especially true for multipurpose non-keratitis in which there may be no positive slit lamp findings. Fortunately, we can manage most solution sensitivities by either switching the patient to nonpreserved care products or prescribing one-day disposable lenses. CLS

Dr. Campbell is medical director of the Park Nicollet Contact Lens Clinic & Research Center, Minnetonka, Minn. Patrick Caroline is an assistant professor of optometry at Pacific University, Forest Grove, Ore., and director of contact lens research at Oregon Health Sciences University in Portland.