Online Photo Diagnosis

By Gregory W. DeNaeyer, OD, FAAO

Figure 1 shows the right eye of a 56-year-old man who had allergic contact dermatitis, allergic conjunctivitis and keratitis. The patient had been wearing a scleral contact lens on his right eye to improve his visual function after he had developed irregular astigmatism of his corneal graft. He used a multipurpose disinfecting solution to clean and disinfect his lens, and he filled it with preserved saline solution before application. He used preserved artificial tears as needed. He had been wearing the scleral lens for 1 year without incident. During the previous 2 weeks, however, he had been experiencing irritation and redness of the right eye.

Figure 1

I suspected the patient had developed hypersensitivity to one of his lens care solutions, which was triggering his allergic symptoms. I instructed him to immediately stop using his current multipurpose disinfecting solution, saline and artificial tears. I prescribed a hydrogen peroxide care system for cleaning and disinfection and instructed the patient to fill his lens with nonpreserved saline before application. I also advised him to use only nonpreserved artificial tears. At his next follow-up visit (Figure 2), the patient reported his symptoms had completely resolved within 1 week of switching lens care solutions.

Figure 2

Patients can develop delayed hypersensitivity to lens care solutions that can take weeks or months to manifest. Correctly diagnosing a delayed allergic reaction can be difficult because the signs and symptoms can mimic other lens-related complications, and usually patients have not had problems previously with their lens care solution(s). In this case, the flaky patch of irritated skin on the patient's lower lid (Figure 1) was an obvious sign of contact dermatitis. The diagnosis was confirmed when the patients signs and symptoms completely resolved after he switched to nonpreserved lens care solutions. Unfortunately, it is not known which lens care/disinfecting solution was the offending agent, because all of his solutions were switched simultaneously.