A comparison of contact lens-related complications in various daily wear modalities.

PURPOSE: To determine the incidence of contact lens-related complications in various daily wear contact lens modalities. METHODS: The charts of 138 daily wear contact lens patients (35 daily disposable, 34 two week replacement, 34 frequent replacement, and 35 conventional daily wear lens users) were reviewed for subjective and objective contact lens problems. We also looked at two subgroups: first time lens wearers and patients with previous lens-related problems. The rate of lens related complications were calculated as events per person per year (E/P/Y) of lens wear for each year and for the total 3-year study. The percentage of patients in each group who experienced any complication was calculated. We also compared the complication rate for the groups in our current study to the rates calculated for disposable extended wear and conventional extended wear patients from our previous study. RESULTS: We found that the E/P/Y were significantly lower for daily disposable lens wearers, but no significant differences were noted for all other lens wear modalities. There was a trend in most groups toward decreased numbers of complications in the second and third years of lens wear. Of the 23 individual signs and symptoms that were analyzed, three occurred most frequently among daily disposable lens wearers, two were most common in the 2-week replacement group, four occurred most often in frequent replacement patients, and eight were most frequent in conventional daily lens wearers. (In three categories, there were two groups with ties for the highest rate of occurrence, and two categories with zero rates for all groups.) Most of the observed differences in complication rates for individual signs and symptoms did not reach the level of statistical significance. CONCLUSIONS: Daily disposable lens wearers had the lowest overall complication rate.

The effects of therapeutic contact lenses on intraocular pressure measurement.

PURPOSE: To evaluate the accuracy of intraocular pressure (IOP) measurements taken through three commonly used therapeutic contact lenses, using both the Tono-Pen and pneumatonometer. METHODS: We measured the IOP of ten normal eyes and ten eyes with abnormal anterior segments using Tono-Pen, pneumatonometry, and Goldman application tonometry. Three different soft contact lenses (Acuvue, 04, and Permalens) were sequentially placed on the eyes and repeat measurements were taken. The readings obtained for each contact lens were compared to the baseline readings taken without a lens in place in order to assess the effect that each contact lens had on the accuracy of IOP measurements. RESULTS: All three contact lenses permitted accurate IOP measurements in eyes with both normal and abnormal anterior segments. Variations in water content and central thickness did not affect the accuracy of IOP measurements. CONCLUSIONS: Both Tono-Pen and pneumatonometry proved to be equally reliable in recording accurate IOP measurements through therapeutic contact lenses.

Peripheral corneal infiltrates associated with contact lens wear.

PURPOSE: We describe the epidemiological and clinical characteristics of peripheral corneal infiltrates associated with contact lens wear. METHODS: We conducted a retrospective study of 52 patients with contact lens associated peripheral corneal infiltrates. Demographic data, clinical characteristics of the infiltrates, contact lens parameters, treatment modality, and the time to resolution for the infiltrates were analyzed. RESULTS: Forty-four of the 52 patients in this study presented with a single infiltrate, while the remaining 8 patients had multiple infiltrates. Types of contact lenses worn were as follows: 40% of the patients wore disposable extended wear contact lenses; 21% wore conventional extended wear lenses; 19% wore conventional daily wear lenses; 12% used frequent replacement daily wear lenses; 6% wore rigid gas permeable (RGP) contact lenses; and 2% used disposable lenses as daily wear. Although there was no predilection for a specific quadrant of the cornea, when a subgroup of extended wear contact lens patients was analyzed, 19 of their 40 infiltrates were located in the superior quadrant. The epithelium was intact in 42% of the infiltrates, while 58% of the infiltrates had epithelial involvement, either punctate staining or frank defect. Eight of the 16 patients who had corneal cultures performed had positive cultures. All patients who had positive cultures used extended wear contact lenses. Smoking did not appear to have an effect on the associated inflammatory reaction, positive cultures, or time to resolution. Seventy-five percent of patients were treated with topical antibiotics. Antibiotic steroids were prescribed for 23% of patients, and 2% of patients were treated with topical steroids. The mean time to resolution for all infiltrates was 1.74 weeks. CONCLUSIONS: Focal peripheral infiltrates with or without epithelial disturbance represent a distinct clinical complication associated with contact lens wear. All patients in this study had resolution of their infiltrates without complications. We recommend that after resolution of corneal infiltrates, patients should be refit with daily wear soft or RGP contact lenses.

Peripheral corneal infiltrates associated with contact lens wear.

PURPOSE: A retrospective study was performed to review the clinical characteristics of peripheral corneal infiltrates in contact lens wearers. METHODS: The charts of all contact lens patients with peripheral corneal infiltrates 1.5 mm or less in size who presented to the office from 1987 to 1994 were reviewed. RESULTS: The epidemiological and clinical characteristics of peripheral corneal infiltrates associated with contact lens wear were reviewed in 52 patients (64 infiltrates). Forty-four patients presented with a single infiltrate, while the remaining 8 patients had multiple infiltrates. While there was no predilection for a specific quadrant of the cornea, when a subgroup of patients who wore extended wear lenses was analyzed, 19 of the 40 infiltrates were located in the superior quadrant. Forty percent of the patients were wearing disposable extended wear contact lenses, 21% were wearing conventional extended wear lenses, 33% were wearing conventional or frequent replacement/disposable daily wear contact lenses and 6% were wearing rigid gas permeable lenses. The majority of patients had minimal conjunctival inflammation, an anterior stromal cellular reaction and minimal anterior chamber activity. A subgroup of 16 patients had corneal cultures of their infiltrates. In this group, 8 of the 16 had positive cultures. All patients had a resolution of the infiltrates without complications and the majority were refitted to daily wear soft or rigid contact lenses. CONCLUSION: Peripheral corneal infiltrates in contact lens wearers appears to be more common in patients wearing extended wear soft contact lenses. While often considered "sterile" in the literature, a significant number have been shown to be culture-positive. The organisms that have been associated with peripheral infiltrates appear to be less "pathogenic" than those that have been reported to be associated with central corneal ulcer. However, it is probably advisable that patients with peripheral corneal ulcers secondary to contact lens wear should be initially treated with topical antibiotics.

Changes in refraction and keratometry after surgery for acquired ptosis.

A retrospective study involving 47 lids in 26 patients was conducted to determine changes in refraction and keratometry after surgery for acquired ptosis. Refractive and keratometric data were obtained prior to and 6 months after levator surgery. Data were analyzed for changes in refractive sphere, cylinder, and cylindrical axis, as well as keratometry, toricity, and axis of toricity. Although patients noted subjective change in vision postoperatively and demonstrated changes in their refractive error, the changes were statistically insignificant. Consistency was noted; the cylindrical axis and the axis of toricity remained relatively stable after surgery.

A comparison of conventional and disposable extended wear contact lenses.

The charts of 126 extended wear contact lens patients (65 disposable and 61 conventional extended wear lens users) were reviewed for subjective and objective contact lens problems. We found that the number of complication events per person per year of lens wear was higher for conventional extended lens wearers than for disposable extended wear patients. There was a trend in both groups toward decreased numbers of complications in the second and third years of lens wear. Within each group, we also examined first time lens wearers and patients with a history of contact lens related complications. Both of these subgroups also fared better with disposable lenses, with fewer complication events per year and fewer complications overall. Of the 20 individual signs and symptoms that were analyzed, 13 occurred more frequently among conventional extended wear lens users; this difference was statistically significant for itching, burning and dryness, poor vision, foreign body sensation, torn and lost lenses, giant papillary conjunctivitis, mucus, and superficial punctate keratopathy. Five signs were more frequent among the disposable extended wear lens users, but the difference was not statistically significant. There were no cases of ulcerative keratitis in either group. The average wearing time was 11.2 +/- 5.9 days for conventional extended wear patients and 6.7 +/- 2.3 days in the disposable group. The difference in wearing time between the two groups may have been a factor in the higher complication rate among conventional extended wear lens patients.

Causative factors in unilateral giant papillary conjunctivitis.

Giant papillary conjunctivitis (GPC) is usually a bilateral disease. However, in a small number of cases, GPC can be manifested as a unilateral, or a markedly asymmetrical disease in patients wearing bilateral contact lenses. We reviewed the clinical records of 148 patients with GPC to determine the incidence of unilateral GPC and its causative factors. Specifically, charts were reviewed for data on refractive error, keratometry, lens fit, lens care, lens replacement, and the presence or absence of associated ocular abnormalities (dry eyes, blepharitis, previous injury, or surgery). Fourteen patients with unilateral or markedly asymmetrical disease were identified. Overall, no statistically significant difference was found in lens care, refractive error, or keratometric measurements in the affected and unaffected eyes. While not statistically significant, infrequent lens replacement appears to be an important factor in the development of unilateral GPC. Three patients had a history of wearing an older lens in the GPC eye. Two patients were found with unilateral meibomian gland dysfunction involving the affected eye, and one patient had undergone surgery on the affected eye. No causative factor was identified in eight cases.

Inflammatory and papulosquamous disorders of the skin and eye.

We have discussed herein the dermatologic and ocular manifestations of several inflammatory diseases. Cooperation between ophthalmologists and dermatologists can significantly enhance patient care and comfort. It is hoped that this review will stimulate increased awareness of the prevalence of ocular findings in these diseases and encourage cooperation between these specialties for the benefit of our patients.

Allergic ocular disorders: a spectrum of diseases.

Allergic eye disease is commonly encountered in clinical practice. The external eye is exposed to a host of environmental, cosmetic, and pharmacologic antigens. Although individual responses show a wide range of variability, a number of distinctive syndromes have emerged to define the spectrum of allergic eye disease. They consist of seasonal allergic conjunctivitis (SAC), perennial allergic conjunctivitis (PAC), atopic keratoconjunctivitis (AKC), vernal keratoconjunctivitis (VKC), giant papillary conjunctivitis (GPC), and contact allergies involving the conjunctiva.

Treatment of giant papillary conjunctivitis with cromolyn sodium.

We evaluated the efficacy of cromolyn sodium in the management of contact lens patients with GPC. Fourteen of 20 patients (70%) with moderate to severe giant papillary conjunctivitis (GPC) were able to continue wearing contact lenses with the use of 4% sodium cromolyn eye drops. These patients had all failed to stay symptom free with our standard method of treatment (i.e., discontinuing contact lens wear for 1-2 weeks; improving lens care; and refitting with different lens designs and/or polymers). This study examined the indications, therapeutic regimen, complications, and patient response to the use of sodium cromolyn in contact lens patients with GPC.

Neutrophil chemotactic factors derived from conjunctival epithelial cells: preliminary biochemical characterization.

We have previously reported on the release of neutrophil chemotactic factors (NCF) from injured conjunctival tissue. The present study was designed to biochemically characterize these conjunctiva-derived chemotactic factors and determine their biological activities. Bulbar conjunctiva was surgically removed from a rabbit eye and incubated with 250 microL of minimal essential medium (MEM) for 6 hours at 37 degrees C in a 5% CO2 atmosphere. Chemotactic activity was assayed using modified Boyden chambers with rabbit peritoneal neutrophils as indicator cells. Following treatment with subtilisin protease for 90 minutes, chemotactic activity of the conjunctival factors was reduced by 74%. Similarly, activity was lost after heating at 56 degrees C for 60 minutes (41% inhibition). Using ultrafiltration techniques, we showed that the majority of the chemotactic activity remained above a 100 kilodalton filter, suggesting the existence of high molecular weight factors. We also showed that the conjunctival factors are not glycoproteins and bind to both anion and cation exchange resins. When 100 microL of conjunctival supernatant was injected in the superior tarsal conjunctiva of rabbits, significant recruitment of neutrophils was evident by 4 hours. Control rabbits injected with MEM did not show neutrophil recruitment. Results of these studies indicate that NCF from traumatized conjunctival tissue are proteins (and not glycoproteins) of high molecular weight, heat labile, exhibit anionic and cationic charges, and are active in vivo.

Factors affecting therapeutic concentration of topical aminocaproic acid in traumatic hyphema.

Epsilon-aminocaproic acid (EACA) decreases rebleeding in traumatic hyphema through antifibrinolytic activity. Therapeutic levels were achieved in aqueous humor of rabbits after topical application. Aqueous humor EACA levels were significantly higher after pretreatment with 0.5% proparacaine. Use of EACA (60%) in a carboxypolymethylene (CPM) vehicle (0.5%, 1%, 2%, 3%, and 4%) was examined. Aqueous humors levels at 4 hours ranged from 6.18-20.42 micrograms/ml. The 2% and 3% formulas achieved the highest concentrations in aqueous. Use of EACA (15%, 30%, 40%, and 60%) in 4% CPM was also studied. At 2 and 4 hours after treatment, the 30% EACA solution most effectively achieved therapeutic levels. Velcro closure devices were attached to the rabbit's eyelids, and 200 microliters of 30% EACA in 2% CPM was administered. After 3 hours the patched eyes had a mean aqueous EACA level of 60.09 micrograms/ml compared with 8.97 micrograms/ml in unpatched eyes. When dose size was studied in patched eyes, 200-microliters doses achieved aqueous levels of 60.09 micrograms/ml, and 100-microliters doses resulted in levels of 10.40 micrograms/ml. Since epithelial toxicity was observed in eyes that had been patched, the optimum topical regimen appeared to be 200 microliters of 30% EACA in 2% CPM every 6 hours in unpatched eyes.