contact lens case reports

Epitheliopathy in Contact Lens Wearers

BY PATRICK J. CAROLINE, FAAO, & MARK P. ANDR�, FCLSA
FEBRUARY 1999

Infectious microbes, mechanical trauma, chemical toxicity or hypersensitivity and allergic antigens may cause inflammation of the cornea and conjunctiva.The following are two recent cases of unilateral epitheliopathy in which contact lens care solution toxicity or hypersensitivity was suspected.

Lens Induced SLK

L.S. is a 38-year-old female with a 20-year history of daily wear soft lenses. She was using a nightly multipurpose disinfection system with a daily liquid enzyme and had a one-month history of mild burning, photophobia and decreased lens tolerance in only her left eye. Visual acuities were OD 20/20 and OS 20/70. Slit lamp examination revealed a coarse, thickened epithelium, originating at the superior limbus and progressing centrally in a V-shaped wedge with its apex toward the pupil (Fig. 1). There were no significant superior bulbar changes, however, photokeratoscopy showed significant superior corneal distortion encroaching on the visual axis. Her right eye was normal with no corneal or conjunctival changes. Despite the unilateral nature of the condition and the lack of superior bulbar findings, L.S. was diagnosed with contact lens induced SLK. L.S.'s condition resolved after discontining lens wear and using preservative-free ocular lubricants four times a day.

Advancing Epitheliopathy

T.K. is a 31-year-old female with a 10-year history of daily soft contact lens wear. She was using a multipurpose lens care system for nightly disinfection and complained of a six-week history of ocular irritation, photophobia and total lens intolerance in her left eye only. Visual acuities were OS 20/20 and OS 20/200. Slit lamp examination revealed waves of coarse, thickened epithelium with clearly defined borders extending from the superior limbus toward the visual axis (Fig. 2). No conjunctival lesions or irregularity were noted in the superior bulbar conjunctiva or along the adjacent limbus.

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This condition resembled an entity first described by Aversa et al., (Ophthalmology 1997). Two patients (3 eyes) had been chronically exposed to anti-glaucoma medications and two patients (4 eyes) were exposed to nightly use of multipurpose contact lens care products. In each case, the epitheliopathy consisted of a wave-like plaque of coarse, irregular epithelium originating from the superior limbus. The superior bulbar conjunctiva was normal. Treatment for this condition consists of lens discontinuation and a two-month course of preservative free artificial tears.

We have presented two cases in which solution toxicity or immune hypersensitivity reactions resulted in a corneal epitheliopathy. Are lens induced SLK and advancing wave-like epitheliopathy simply different manifestations of the same condition? This question is debatable, but the treatment remains the same.

Patrick Caroline is an associate professor of optometry at Pacific University and an assistant professor of ophthalmology at the Oregon Health Sciences University. Mark Andr� is director of contact lens services at the Oregon Health Sciences University.