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Ordering Lenses Without an Rx ­ The Dangers Revealed
BY BRIAN E. MATHIE, OD

Patient MM is a 46-year-old white male who reported to my clinic two days after he developed soreness and discomfort in the right eye. He confessed that he had worn extended wear soft contact lens, which was not fitted or prescribed for him. He ordered the soft lens over the Internet without a prescription. He is a previous GP contact lens wearer, and he used the power of his GP contact lenses to order the soft contact lenses. He also reported that his vision had decreased, and he was very photophobic.

His vision with glasses was 20/200 OD, 20/60 OS. Slit lamp examination revealed a 3mm ulcer OD with surrounding infiltrates. There was corneal edema and grade 1+ to 2+ conjunctival injection. He denied using any homemade saline. We also noted mucopurulent discharge grade 1+, and the anterior chamber was deep and quiet.

Figure 1. Example of a contact-lens induced corneal ulcer (not patient MM).

Treatment

We started patient MM on Ocuflox (Allergan), a fluoroquinolone antibiotic, every 15 minutes for two hours, then every 30 minutes for four hours, then hourly. The patient also used Ciloxan ointment (Alcon) before bed. He followed up in one day, at which time vision was reduced to count fingers at one foot due to grade 3+ corneal edema. The corneal ulcer appeared approximately the same and was located proximal and temporal to the pupil. There was no positive culture. Figure 1 shows a contact lens-related ulcer in a different patient.

He returned daily without any visual improvement; however, on Day 5, the ulcer improved to 2.1mm in size and best corrected vision improved to 20/30. Superficial punctate keratitis remained overlying a 2.2mm area of remaining infiltrates and haze. We prescribed Ocuflox every four hours, and the patient continued to use Ciloxan ointment in the right eye before bed.

Patient MM has finally healed from the ulcer, but a significant corneal scar remains (Figure 2). The scar is 2.2mm in size and is visually significant in scotopic conditions.

	Figure 2. Resultant scar from patient MM's lens-induced ulcer.

Professional Care is Key

A retrospective study (Rattanatam 2001) showed that of 299 corneal ulcers diagnosed at Wills Eye Hospital from January 1, 1996 to June 30, 1999, 12.4 percent were related to contact lens use. Contact lenses that are abused or misfit can result in various complications including bacterial keratitis. Even when treated appropriately, the resulting scar may permanently debilitate vision.

This case demonstrates the potential serious conditions that could affect many contact lens patients if eyecare professionals do not monitor lens fit and ocular health. It also emphasizes that telephone and e-mail ordering of contact lenses must be more closely policed to protect the ocular health of our patients. 

Dr. Mathie is clinic director for Roholt Vision Institute in North Canton, Boardman and Alliance, OH. He is also an adjunct faculty member of The Ohio State University College of Optometry.