Recurrent episodes of irritation and infection from contact lenses may range in severity from mild redness and discomfort during prolonged wear, to more severe and sight-threatening complications such as bacterial keratitis and corneal ulceration. Fortunately, most contact lens “infections” are not infections at all, but instead are chronic recurrent inflammatory or allergic conditions associated with contact lenses. Patients sometimes forget, that no matter how advanced contact lens technology may become, a contact lens is still an artificial plastic foreign body in the eye which nature never intended to be there.
Most contact lens irritations which cause redness, soreness, and a mild discharge can be attributed to simple problems such as poorly fitting or dirty contacts, contact lens overwear, or an underlying dry eye condition. In these cases, there is no real infection present, although patients may refer to the redness and irritation incorrectly as “conjunctivitis”. Conjunctivitis, or pink eye in layman’s terms, more correctly refers to infection of the conjunctiva and may be viral or bacterial in etiology.
One special case of chronic contact lens irritation is Giant Papillary Conjunctivitis, or GPC, in which the patient develops an allergic response to proteins that bind to the contact lens. GPC results in redness, a foreign body sensation, itching, a mucous discharge, and a proliferation of papillae, or bumps, on the inner surface of the lids which cause discomfort. Unfortunately, medications do not treat this condition effectively, the only alternative being a drastic reduction of contact lens wearing time, or in many cases, a complete cessation of contacts.
Bacterial keratitis and corneal ulceration occur infrequently in patients who do not abuse contacts but are very serious sight-threatening conditions that cause severe pain, inflammation, light sensitivity, and if untreated, may cause scarring, corneal perforation, and permanent loss of vision. The risk of bacterial keratitis increases significantly in patients using extended wear lenses, especially if lenses are worn more than two weeks continuously.
Patients with chronic recurrent contact lens irritation and GPC may be excellent candidates for laser vision correction and LASIK. Very simply put, contact lenses cannot irritate the eye if they are not needed. In addition, patients who may not be able to wear contacts comfortably due to an underlying dry eye condition may still be excellent candidates for LASIK. Certain precautions and procedures must be undertaken in patients with dry eye syndrome undergoing LASIK; however, LASIK does not permanently worsen dry eyes.
LASIK may be an outstanding alternative to contacts in patients who have previously had serious corneal infection and ulceration. Microscopic scarring of the cornea from infection or ulceration is not an absolute contraindication to laser vision correction and LASIK. In fact, the laser vision correction procedure can be specifically designed to remove the microscopic scar tissue as well as correct the patient’s prescription.
Next in our series: “I’m over 40 and I hate these reading glasses!” Is LASIK Monovision for me?