IT IS NOT UNCOMMON for patients to get some sort of deposits on their contact lenses. Here, an exploration of two case reports with lens deposition issues.
CASE #1
A 24-year-old female patient reported with a chief complaint of redness of her left eye associated with blurred vision and light sensitivity over the past month. She had a history of extended wear soft lens use but was currently wearing glasses. Her best-corrected visual acuity (BCVA) OS measured count fingers at 5 feet. Slit lamp examination by a cornea specialist revealed that the patient had a severely deposited soft contact lens that was adhered to her left cornea.
Upon removal of the contact lens (Figure 1), the cornea had extensive vascularization, haze, and nummular lesions that exactly matched the pattern of the lens jelly bump deposits (Figure 2).
The patient was prescribed prednisolone acetate 1% six times per day OS and nightly lubricating ointment. At her follow-up appointment one week later, her vision improved to BCVA 20/200. The cornea was mildly edematous with neovascularization, stromal scarring, and reduced sensitivity. The prednisolone was tapered to q.i.d. OS. At her next one-week follow-up, the corneal edema had resolved, and the steroid was tapered off. The patient was advised not to wear contact lenses with close monitoring over the subsequent six months.
CASE #2
A 21-year-old male patient who wears a scleral lens (tisilfocon A, Dk/t 180) for his right eye secondary to high astigmatism complained of deposits on his two-year-old lens. Visual acuity OD measured 20/20 and slit lamp exam showed heavy central lens deposits (Figure 3). The previous year’s exam noted mild central deposition on his lens that he cleans nightly with hydrogen peroxide disinfecting solution. At that appointment, he was advised to add a cleaner, which he started periodically using every three months.
After discussion at his most recent visit, a duplicate replacement lens was ordered, switching the material to hofocon A that has a Dk/t of 97. Additionally, the patient was advised to digitally clean the lens with a GP cleaner prior to the hydrogen peroxide overnight storage. Finally, it was recommended that he increase the frequency of the Progent treatment to monthly.
The increased use of daily disposable lenses has drastically reduced the incidence of clinically relevant lens deposition. However, lens deposits can still be an issue for continuous wear or daily wear specialty lenses that have less frequent replacement schedules. Differences in tear chemistry can dramatically vary the incidence of deposits from patient to patient. Reducing or eliminating deposits with lenses often involves lens replacement, lens material variation, extra strength cleaners, or the addition of polyethylene glycol coatings.
Eliminating lens deposits is critical to success and avoiding the secondary complications that include vision disruption, decreased comfort, contact lens papillary conjunctivitis, corneal inflammation, and microbial keratitis (Wagner, 2020; Cope et al, 2017; Allansmith et al, 1977).
Acknowledgment: I would like thank Carrie Lembach, DO, for her assistance with the article.
REFERENCES
1. Wagner, H. The How and Why of Contact Lens Deposits. Review of Cornea and Contact Lenses. 2020 May. Available at reviewofcontactlenses.com/article/the-how-and-why-of-contact-lens-deposits. Accessed 2024 Oct 2.
2. Cope JR, Collier SA, Nethercut H, Jones JM, Yates K, Yoder JS. Risk Behaviors for Contact Lens-Related Eye Infections Among Adults and Adolescents - United States, 2016. MMWR Morb Mortal Wkly Rep. 2017 Aug 18;66:841-845.
3. Allansmith MR, Korb DR, Greiner JV, Henriquez AS, Simon MA, Finnemore VM. Giant papillary conjunctivitis in contact lens wearers. Am J Ophthalmol. 1977 May;83:697-708.
