Contact Lens Complications

Contact lens is valuable optical device used in the presence of severe refractive error and treatment of certain chronic diseases. Contact lens can be used for many years without problems only if they are made of well-chosen material, correctly shaped, and properly fitted. The ocular complications range from harmless irritation to sight-threatening corneal ulceration and even loss of eye.

Many patients have associated dry eyes or blepharitis, which further compromise the conjunctival and corneal surface, increasing the chances of complications. With advances in manufacturing techniques, advances in lens materials, and improved hygienic measures, frequency of complications has decreased.

Corneal staining

Corneal staining is probably the most familiar of all potential contact lens complications. The prevalence is as high as 60% and is generally clinically insignificant.

Epithelial microcysts

Epithelial microcysts are an important indicator of chronic metabolic stress and can be readily observed with the slit-lamp biomicroscope. It is usually seen in the central and paracentral cornea. They appear as minute scattered gray opaque dots with focal illumination and as transparent refractile inclusions with indirect retroillumination. Visual acuity is generally unaffected by microcysts. They are usually seen with soft contact lens, especially with extended wear lens. The presence of a small number of microcysts is not dangerous, but a large number of microcysts represent epithelial metabolic distress. It can be treated by decreasing the frequency of overnight wear, changing to daily wear, or increasing the frequency of lens replacement.

Epithelial edema

A small number of vacuoles and bullae can be seen in the corneas of contact lens wearers. They are clinically innocuous but can be confused with other small epithelial inclusions which are clinically more serious. It is the most common and earliest corneal change due to hypoxia.

On slit-lamp biomicroscopy, vacuoles appear as spherical bodies located within the corneal epithelium with perfectly rounded and distinct edges. They are innocuous and are not apparently associated with any adverse symptom.

Epithelial wrinkling

Epithelial wrinkling is a severe ocular complication of contact lens wear and is characterized by the appearance of a series of deep parallel grooves in the corneal surface giving the impression of a “wrinkled” effect. The treatment protocol is to stop lens wear and reassure patients. The prognosis for recovery following epithelial wrinkling is good.

Endothelial changes

Endothelial bleb, endothelial bedewing, polymegathism, and pleomorphism are the endothelial changes seen in contact lens wearers. These are thought to be due to series of events following hypoxia. Contact lens-associated endothelial bedewing is seen as small inclusions in the region of the inferior central cornea near to or immediately below the inferior pupil margin. They appear at the level of the endothelium and are bilateral. These can be reduced by the use of daily wear lens and rigid gas permeable lens.

Other corneal changes following contact lens use include superficial punctate keratitis, corneal abrasions, and corneal neovascularization.

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