Online Photo Diagnosis

By William Townsend, OD, FAAO

This 32 year-old male, a long-time contact lens wearer, presented for evaluation; his only complaint was reduced vision and a request for a new contact lens prescription. Presenting visual acuities with contact lenses were 20/20 OD and OS. Examination revealed well-centered lenses that moved with blinking. In the left eye, we noted what appeared be a u-shaped tear in the lens. However, when the patient blinked, the lesion did not move with the lens. This linear lesion was very thin, and it stained brightly after we instilled 2% sodium fluorescein.

The linear lesion remained after the contact lens was removed. Under higher magnification, we were able to visualize a very fine fiber embedded in the staining area. After removing the fiber with forceps, we carefully examined it and determined that it was a single strand; it was very straight, lacking any waves or curls, and probably was a synthetic material.

Patients present with numerous forms of contact lens-associated staining. The goals of treatment include pain management, prevention of infection, and healing. Contact lens-related abrasions have been associated with bacterial keratitis, particularly from Pseudomonas. These injuries should be treated with anti-pseudomonal topical antibiotics.¹ Bandage contact lenses have gained great popularity as a therapeutic measure for corneal abrasions, often supplanting pressure patching as the treatment of choice. In a multinational study in 2013, Menghini et al compared pressure patching, bandage contact lenses, and ophthalmic antibiotic ointments for managing corneal abrasion. The primary endpoint was the difference in mean abrasion area at baseline, one day, and one week. They found no statistical difference in corneal abrasion area at any time point, and all the subjects had resolution of the abrasion after seven days.²

In our case, the lesion was very shallow, more of an impression in the epithelium caused by compression between the posterior surface of the contact lens and the surface cells of the corneal epithelium. The lesion totally resolved without treatment within 24 hours.

Catania LJ. Management of corneal abrasions in an extended-wear patient population. Optom Clin. 1991;1(3):123–33.

Menghini M. et al. Treatment of traumatic corneal abrasions: a three-arm, prospective, randomized study. Ophthalmic Res. 2013;50:13–18