Treatment Plan

Managing Traveler’s Contact Lens-Associated Keratitis

BY WILLIAM L. MILLER, OD, MS, PHD, FAAO

The increasing mobility of the public and the greater level of international travel have heightened the risk of various disease states related to traveling. Most of this risk is related to systemic maladies that are caused by bacterial or viral vectors. However, issues related to travel can affect the eye, as evidenced by a 1998 letter to the editor in The New England Journal of Medicine by Paul Donzis, MD, who described the necessity of including antibiotic ophthalmic medications in emergency kits for those traveling to remote areas of the world (Donzis, 1998). Eyecare practitioners are already familiar with the environmental challenges that patients may encounter when traveling; additionally, patients should be educated on contact lens complications that may occur when they travel.

A Newly Recognized Condition

A recently described entity related to international travel has been coined Traveler’s Contact Lens Associated Keratitis (TCLAK) (Ukpe, Youlios et al, 2013; Ukpe, Parekh et al, 2013). We can argue as to whether this is truly a new ocular disease; however, the caveats derived are well worth paying attention to by our contact lens wearers who travel internationally. Patients at risk for TCLAK are similar to those at risk for other contact lens-associated cases of keratitis, including patients who are immunocompromised, smokers, and young contact lens wearers. Additionally, those traveling to warm, tropical regions of the world are at a greater risk for TCLAK.

While similar to typical cases of contact lens-associated keratitis, the moniker TCLAK comes from habits related to travel, such as contact lens overwear, inadequate attention to cleaning and disinfection, and exposure to increased microbial loads in areas outside of the United States. Higher visual morbidity has been demonstrated in TCLAK due to inadequate availability of eye care overseas, thus decreasing the possibility of early detection, a major factor in decreasing visual morbidity in lens-associated keratitis. Although guidelines exist for contact lens safety from various organizations, most are silent on listing travel as a risk factor for contact lens-associated keratitis.

Prevention and Management

While this column is usually about treatment, with TCLAK the focus is on managing patients prior to anticipated travel. This includes a careful assessment of contact lens care habits and educating patients on the signs and symptoms of TCLAK. Also review their wearing habits and instruct them on the dangers of overwearing their contact lenses while traveling.

Backup spectacles are an essential addition to any traveler’s luggage. This might also be a great indication for single-use lenses that avoid the necessity of care systems. Instruct patients to remove lenses if they experience irritation, redness, and a decrease in vision—and to seek medical care as soon as possible.

As Dr. Donzis suggested in 1998, the inclusion of ophthalmic antibiotic drops in emergency kits for those traveling to remote areas of the world appears to be a wise recommendation. Your role in educating patients in proper lens use and avoidance of indiscriminate application is essential.

As Benjamin Franklin once said, an ounce of prevention is truly worth a pound of cure in the case of TCLAK. This is worth repeating—over and over—to your contact lens patients who travel abroad. CLS

For references, please visit www.clspectrum.com/references and click on document #230.

Dr. Miller is an associate professor and chair of the Clinical Sciences Department at the University of Houston College of Optometry. He is a consultant or advisor to Alcon and Vistakon and has received research funding from Alcon and CooperVision and lecture or authorship honoraria from Alcon and B+L. You can reach him at wmiller@uh.edu.