IT HAS BEEN established that sleeping in contact lenses increases the risk for ocular infections and sight-threatening cases of microbial keratitis that may involve Pseudomonas aeruginosa and Acanthamoeba (Goodlaw, 1996; Cope et al, 2018; Sauer et al, 2020; Stapleton et al, 2020). Corneal inflammation, accompanied by peripheral sterile infiltrates, may also develop (Stapleton et al, 2020; Baum and Dabezies, 2000) (Figure 1). To avoid these serious adverse effects, it is important to educate patients on proper contact lens care, hygiene, and habits.

However, could there be times when eyecare providers might purposely look past these potential complications and advise patients to sleep in their contact lenses? Yes. This article will explore ways in which rigid GP, soft, and scleral contact lenses are used overnight, and while sleeping, to treat and rehabilitate the cornea.

Overnight orthokeratology (OOK) involves flat-fitting rigid GP lenses worn overnight to temporarily reshape the corneal surface, thereby reducing myopia and even playing a role in myopia control (Bullimore and Johnson, 2020). This process allows for good vision, without glasses or contact lenses, during waking hours. OOK has also demonstrated slowing of axial elongation (Bullimore and Johnson, 2020).

Slowing axial elongation may ultimately help to reduce myopia-associated ocular pathology, such as myopic maculopathy, open-angle glaucoma, posterior subcapsular cataract, and retinal detachment (Bullimore et al, 2021). Even after considering treatment risks of ocular inflammatory events and microbial keratitis, the potential benefits of myopia control using overnight ortho-k were determined by Bullimore and colleagues (2021) to outweigh the risks.

Soft lenses have been utilized as extended wear bandage soft contact lenses (BSCLs), offering protection of the ocular surface. In acute postoperative settings, BSCLs have been used to minimize ocular pain, protect the compromised epithelium from environmental stressors, and promote reepithelialization.

These lenses have also been helpful in cases of corneal abrasions, recurrent corneal erosion, persistent epithelial defects, and over tissue adhesives for corneal perforations (Jacobs et al, 2021).

The potential for infection is always present with extended and overnight BSCL wear, but in these special situations, the lens acts as a critical therapeutic treatment for the cornea. Once applied to the eye, these lenses are worn continuously until the ocular surface has healed. The total duration of wear depends on ocular healing time, and lenses can be carefully replaced to optimize the condition as needed.

Scleral lenses also play an important role in treating and protecting the ocular surface. While they are frequently worn daily to address dry eye, scleral lenses can also be worn overnight to address persistent epithelial defects nonresponsive to other therapies (Jacobs et al, 2021; Tappin et al, 2001).

While some cases of extended wear utilize scleral lens wear at all times except for lens cleaning and replacement of reservoir contents every 12 hours (He et al, 2018), some have allowed continuous wear for 10 or 14 days, even incorporating additives such as amniotic membranes and serum tears (Khan et al, 2019).

Time to achieve complete reepithelialization can vary, but has been reported as 11.1±5.5 days in a case series (Khan et al, 2019). Sometimes topical antibiotics can be added within the fluid reservoir to protect against microbial infection (He et al, 2018).

As demonstrated by these unique applications of overnight contact lens wear, the rules are not always black and white. Sometimes, taking cautious risks may be necessary to treat the cornea in challenging circumstances. CLS

References

1. Goodlaw E. Risk of infection from sleeping with contact lenses on: causes of risk. Optom Vis Sci. 1996 Mar;73:156-158.
2. Cope JR, Konne NM, Jacobs DS, et al. Corneal Infections Associated with Sleeping in Contact Lenses - Six Cases, United States, 2016-2018. MMWR Morb Mortal Wkly Rep. 2018 Aug 17;67:877-881.
3. Sauer A, Greth M, Letsch J, et al. Contact Lenses and Infectious Keratitis: From a Case-Control Study to a Computation of the Risk for Wearers. Cornea. 2020 Jun;39:769-774.
4. Stapleton F, Bakkar M, Carnt N, et al. CLEAR - Contact lens complications. Cont Lens Anterior Eye. 2021 Apr;44:330-367.
5. Baum J, Dabezies OH Jr. Pathogenesis and treatment of “sterile” midperipheral corneal infiltrates associated with soft contact lens use. Cornea. 2000 Nov;19:777-781.
6. Bullimore MA, Johnson LA. Overnight orthokeratology. Cont Lens Anterior Eye. 2020 Aug;43:322-332.
7. Bullimore MA, Ritchey ER, Shah S, Leveziel N, Bourne RRA, Flitcroft DI. The Risks and Benefits of Myopia Control. Ophthalmology. 2021 Nov;128:1561-1579.
8. Jacobs DS, Carrasquillo KG, Cottrell PD, et al. CLEAR - Medical use of contact lenses. Cont Lens Anterior Eye. 2021 Apr;44:289-329.
9. Tappin MJ, Pullum KW, Buckley RJ. Scleral contact lenses for overnight wear in the management of ocular surface disorders. Eye (Lond). 2001 Apr;15:168-172.
10. He X, Donaldson KE, Perez VL, Sotomayor P. Case Series: Overnight Wear of Scleral Lens for Persistent Epithelial Defects. Optom Vis Sci. 2018 Jan;95:70-75.
11. Khan M, Manuel K, Vegas B, Yadav S, Hemmati R, Al-Mohtaseb Z. Case series: Extended wear of rigid gas permeable scleral contact lenses for the treatment of persistent corneal epithelial defects. Cont Lens Anterior Eye. 2019 Feb;42:117-122.