treatment plan

Contact Lenses and Pink Eye

BY TIMOTHY T. MCMAHON, OD, FAAO
May 2001

The vast majority of eye infections are viral in origin. Adenovirus (pink eye) is one of the more common culprits. It is spread by direct contact, aerosol droplet and indirectly through fomites like a used drinking glass or a pillowcase. These viruses can spread like wildfire through a school or community depending on the type. Hallmark features include serous discharge, mucus discharge, conjunctival edema and injection, conjunctival follicles, lid edema, light sensitivity and ocular irritation or pain. A preauricular node may also appear on the involved side.

Corneal Involvement

An adenovirus infection that affects the cornea is called epidemic keratoconjunctivitis (EKC). Corneal involvement is rather common, initially presenting as intraepithelial fuzzy inclusions of virus and inflammatory cells, frequently followed by underlying subepithelial infiltrates that may be thick and elevated. The infiltrates persist for weeks and can cause light sensitivity, reduced acuity and irritation. Topical steroids will rapidly melt these infiltrates, but avoid using them where possible. The infiltrates can rebound when the steroids are discontinued, making it difficult to get the patient off steroids.

Consider patients contagious while they are symptomatic or for two weeks after the onset of symptoms for the second eye.

Strains that lead to EKC can live for up to a month in a dormant phase on counter tops, door knobs and other surfaces and can be transmitted to anyone who happens to touch them and then a mucus membrane.

Treatment

During active infection, contact lenses are rarely tolerated and should be discontinued. Have patients soak rigid lenses in hydrogen peroxide for 10 minutes per CDC recommendations to disinfect the lenses.

Soft lens solutions will kill adenovirus, but viral fragments may remain that can generate a recurrent infection. Disposing of soft contact lenses is the best course of action. Have patients discard their lens cases and solutions as well. I also have patients disinfect areas such as their medicine cabinets where they keep their contact lens gear with Lysol or equivalent as a precaution.

Patients with conjunctival involvement can return to normal contact lens wear when the signs and symptoms have resolved. The conjunctival follicles are the last sign to depart, and typically patients will not be comfortable with their lenses while a significant follicular response remains. Some patients may experience reduced contact lens comfort for several weeks after the infection. Beyond providing fresh lenses, nothing I have tried alters this course, so patience on everyone's part is required.

For those with corneal involvement, two lasting features are common. First, affected individuals "feel" their eyes more than they did before the infection. This physical awareness is irritating but not painful. Second, contact lens tolerance is poor. The poor lens tolerance may persist up to a year from the active phase of the infection and is not dependent on continued subepithelial infiltrates. I know of nothing that can remedy this situation. Spectacles are the best course until the patient is comfortable again, though if the patient chooses to struggle with lens wear there does not appear to be any harm.

On rare occasions you may need to prescribe rigid lenses for those with persistent infiltrates and reduced spectacle corrected vision.

Dr. McMahon is an associate professor and Director of the Contact Lens Service at the University of Illinois at Chicago Dept. of Ophthalmology & Visual Sciences.