contact lens case reports
Corneal Infiltrates with Contact Lens Wear
BY PATRICK J. CAROLINE, FAAO, & MARK P. ANDRÉ, FAAO

Corneal infiltrates are associated with a wide range of ocular conditions. They manifest as single or multiple gray or white, well-circumscribed opacities within the epithelial/sub-epithelial layers or the stroma.  They are focal accumulations of inflammatory cells that have migrated into the cornea from the limbal vessels or the tears in response to signals emanating from damaged tissue.

Infiltrates in contact lens wearers are associated with non-infectious (sterile) or infectious causes. The primary factors responsible for non-infectious infiltrates are physiologic stress, such as hypoxia, dry eyes or overnight lens wear; mechanical trauma, such as tight lens fit or trapped post lens debris; or toxic, related to environmental or lens care product reactions. Infectious infiltrates result from epithelial compromise in the presence of microorganisms.

Figures 1a and 1b. Patient's right eye at the time of his initial presentation.

Resolving Infiltrates

Patient OG is a 36-year-old male firefighter with a 20-year history of soft contact lens wear. Most recently the patient had been wearing Vistakon Acuvue 2 lenses for three consecutive nights, with replacement after two weeks of use. When not wearing his lenses overnight, the patient used ReNu MultiPlus solution (Bausch & Lomb) and was rewetting his lenses with Visine drops for contact lens wearers.

The patient presented with a three-day history of red eyes, mild discomfort and a decreased wearing time. Slit lamp examination revealed 2+ conjunctivial injection, diffuse corneal edema, 360 degrees of peripheral neovascularization and multiple peripheral and mid-peripheral infiltrates (Figures 1a, 1b, 2a and 2b).

	Figure 2a and 2b. Patient's left eye at the time of his initial presentation.

We discontinued the patient from contact lens wear and put him on a course of topical steroids for five days. At Day 10, we refit the patient with Vistakon Acuvue 1-Day lenses, OD 8.5mm ­9.00D 14.2mm, OS 8.5mm ­8.00D 14.2mm. He wore the daily disposable lenses for eight weeks, over which time his corneas dramatically improved. Due to the nature of his work, we eventually refit the patient in-to Focus Night & Day (CIBA Vision) contact lenses, which he now successfully wears on a one-week extended wear basis. He disinfects the lenses with CIBA's peroxide-based AOSept Clear Care System and replaces them monthly.

In most cases, the precise cause of inflammatory response and infiltrates remains unknown. A host of factors may cause infiltrates in contact lens wearers, and each should be considered.

Patrick Caroline is an associate professor of optometry at Pacific University and an assistant professor of ophthalmology at the Oregon Health Sciences University.

Mark André is director of contact lens services at the Oregon Health Sciences University.