pediatric and teen cl care

The Most Common Cause of Adverse Events in Children

BY MARJORIE J. RAH, OD, PHD, & JEFFREY J. WALLINE, OD, PHD

The two of us have fit countless children with contact lenses, and occasionally adverse events do occur. Fortunately, the adverse events are rare and haven't resulted in severe vision complications. Here we'll describe two cases that highlight the most common cause of complications in the children that we examine.

Case #1

A 12-year-old girl reported to the clinic complaining of a red, painful left eye since earlier that morning.

Despite education to the contrary, the girl had been wearing orthokeratology lenses on an extended wear schedule, removing them only once or twice a week for cleaning. She reported better vision while wearing the lenses because of uncorrected refractive astigmatism during the day.

Biomicroscopy of the eye revealed a round paracentral corneal ulcer approximately 0.3mm in diameter with an associated anterior chamber reaction. We obtained a corneal culture and initiated treatment with ofloxacin 0.3% ophthalmic solution along with 1% cyclopentolate in the left eye.

The results of the culture revealed Serratia marcescens as the offending microbe. Treatment was successful and the cornea healed in approximately 10 days. Her visual acuity was 20/20 with spectacles in the left eye after treatment.

Ultimately, the child was refit into soft contact lenses for daily wear by another practitioner.

Case #2

A 13-year-old boy reported to the clinic complaining of pain and redness in both eyes.

The boy had been wearing daily disposable soft contact lenses and had been sent home from school by the school nurse with conjunctivitis one week prior to his visit. He continued to wear his contact lenses until the night before the visit, but he denied wearing the contact lenses overnight.

Biomicroscopy revealed an inferior peripheral corneal scar in the left eye with no overlying corneal staining. Grade 2 bulbar conjunctival injection was noted 360 degrees in both eyes. Trace cells were noted in the anterior chamber in the left eye.

We initiated treatment with ciprofloxacin hydrochloride and asked the patient to return the following day.

When the patient returned the next day for follow up, the anterior chamber was quiet in the left eye and the conjunctival injection was greatly reduced in both eyes.

One week later, the condition was completely resolved with no loss of visual acuity. Further pointed questioning of the patient uncovered a history of overnight wear of the daily disposable contact lenses. After re-educating the patient on proper wearing schedule and lens care, the child resumed daily disposable contact lens wear.

Frequent Follow Up Required

Both cases reported here resulted from poor compliance with the wearing schedule. Although education was provided to patients and parents, both children wore the lenses longer than what was prescribed.

These cases emphasize the importance of frequent follow-up visits for this age group and the vigilant reinforcement of proper hygiene and wearing schedules. This is true regardless of the lens type the child is wearing or the replacement schedule.

These cases also highlight the importance of reminding parents to call the practitioner when children show signs of problems (red eyes) or complain of discomfort while wearing contact lenses. CLS

Dr. Rah is an assistant professor at the New England College of Optometry where she works primarily in the Cornea and Contact Lens Service in patient care, teaching and research. Dr. Walline is an assistant professor at The Ohio State University College of Optometry, where he conducts studies of pediatric contact lens wear.