eye infection

Contact lens addicts anonymous

Today's blog post comes to your courtesy a crazy day at the office. This past Sunday (yes, I work Sundays... and yes, I am a little bit crazy... thank you for asking), I felt like I was working in some sort of contact lens emergency clinic. It was like Clearly Contacts was having a sale on eye infections or something! I'm sure the Liberal government backed them on it and I must have missed Trevor Linden's ad campaign on TV...

Moving on...

A while back, I wrote a blog titled Contact Lens Addicts, which explained how some patients become so dependent on their contact lenses that they put themselves at risk of suffering many different problems, some of which could lead to permanent vision loss. Well, Sunday was like a Contact Lens Addicts Anonymous meeting with Dr. Sian mediating.

The CL-AA meeting started with a pleasant, 50-something woman whose contact lens had folded up and tucked itself so far behind her upper eyelid that I almost wished I had a third hand to help flip her eyelid, and/or hold a q-tip, and/or grab the forceps.

Now, lets just take a quick second to answer the question that is likely swirling around in some of your minds... No, the contact lens cannot go so far back that it ends up behind the eyeball. Luckily, the conjunctiva (the thin skin that covers the eye ball) actually folds over itself and covers the inside of the eyelids as well. Effectively creating a natural contact lens catching contraption (and you thought conjunctiva was hard to say).

Next up was a very friendly lady in her mid-thirties who is actually quite good at taking care of her contact lenses. She doesn't over wear them, she replaces them on schedule, and she's good at cleaning them every night (sounds too good to be true, but I believed her). However, despite all of the regular care and maintenance, she managed to fall asleep in her lenses.

Now, we all know that one night stands are a bad idea (right?). Well, sleeping with your contacts is a lot like a one night stand...  There's usually booze involved, it seems like a good idea at the time, you wake up in the morning with something feeling itchy and/or irritated (we're talking about eyes folks!), and then you're doing the walk of shame... into my exam room!

Even for someone who takes care of her contacts, one night with her lenses was enough to cause a small corneal ulcer. Yes, an ulcer. And yes, it is as unpleasant as it sounds.

Last, and certainly not least, is the poor little girl who was actually the impetus for me to write this blog, so I could tell you her unfortunate story. A 16 year old kid who has been wearing Orthokeratology lenses (aka Ortho-K, aka dream lenses). I won't go into detail, but basically these are lenses you only wear at night while sleeping. Hopefully the "only wear at night while sleeping" part raised a red flag or two for most of you. To make matters worse, she was fit for and bought the lenses overseas, so I have no idea what she's been wearing. Not all that different than buying contacts online without being fit for them by a professional, might I add.

But I digress...

The poor kid was in so much pain, she could not open her eye if her life depended on it. When I finally got a look, this is what I saw...

A very red and upset eye with a large, central corneal ulcer. Long story-short, she is and will be in need of a lot of eye drops (as much as every 30-60 minutes all day AND night) and maybe even some oral medications. The worst part of it is that when the infection is finally controlled, this ulcer will likely leave a large scar right in the center of her vision thus causing a permanent decrease in vision in that eye.

 

These were just three of the multiple cases I dealt with during the CL-AA meeting on Sunday.

Its extremely important to understand the consequences of taking our vision for granted. Online sales and deregulation have made it easy to overlook the fact that contact lenses are actually medical devices. They are pieces of plastic that we put on our eye ball to help improve our vision. We should not lose sight of that (pun intended).

I am genuinely concerned and upset about this young girl and so many other patients who suffer from serious issues due to improper contact lens wear and poor ocular hygiene. So, if you or your kids wear contacts, be sure to have the lenses fit by a professional and never hesitate to come in and have your eyes checked if you think something is wrong. As with most things, if we catch it early, its much easier to treat.

 

Note: The pictures are not of my patients, but are accurate representations of their respective issues.

 

 

contact lens addicts

Yesterday I had the not so pleasant experience of having to scare one of my patients out of wearing contact lenses. It inspired me to write a little about contact lenses and those who (over)wear them.

It has occurred to me, over the past year or so, that some patients are addicted to wearing contact lenses. These people are like the crack addicts of the ophthalmic world. They need contacts. They'll do anything to get contacts. They will come in begging for samples. And when you suggest to them that they should quit, they freak out!

For these people, going straight and cleaning up their act means having to wear glasses. And just like any other addiction, its hard for people to quit cold turkey. They come up with all sorts of excuses like "I don't like my frames", "I lost my glasses", "Glasses make my face look fat". Well I got news for you, Chubs... Its not the glasses!

Anyway, this is where I come in. I'm like the motivational speaker on those self help tapes that tell people that they are strong and in control of their lives. "Where there's a will, there's a way" and all that good stuff. Oh and also, if they don't quit, they could go blind.

That last note usually helps me get people's attention. And it worked yesterday with my 19 year old patient who had been wearing coloured contacts (not the best quality lenses) 7 days a week for the last 5 years. She does not own a pair of glasses and therefore has been wearing her contacts from morning until night.

 

Why is this so bad?

The cornea, which is the clear dome at the front of our eyes, has a very high demand for oxygen. The only place the cornea can get oxygen is from the air around us. As you can imagine, covering the cornea with a piece of plastic will significantly reduce the amount of oxygen that gets through. The cells of the cornea starve for oxygen and start to break down causing the cornea to become less clear thus making vision blurry.

The body's response to this lack of oxygen involves creating new blood vessels into the cornea. This is called neovascularization. While this may seem like a good idea, it is actually the exact opposite. If the blood vessels grow too far into the cornea, they can begin to obstruct/distort vision. There is no way to reverse neovascularization of the cornea. It can be stopped or slowed down by decreasing contact lens wear. But if it is very significant, the only treatment is corneal transplant surgery. And believe me when I tell you, you do not want corneal transplant surgery.

Cornea with stitches, post transplant

Cornea with stitches, post transplant

 

Its sad to see a person as young as 19 be at risk of permanent vision loss. But, with a little treatment and staying out of contacts for a while, her eye health (and vision) should improve.

As useful and convenient as they are, contacts can cause a multitude of different ocular problems if worn incorrectly. All patients who wear contact lenses should have regular eye exams.

Contact lenses

They come in a variety of shapes, sizes, and colours...

Soft contact lenses (SCL):These are the most common and they are disposable.

  • This means that after wearing the lenses for a period of time, they are disposed of and a new, fresh pair is used
  • Lenses can be monthly (ex. Air Optix, Frequency 55, Proclear, Biofinity, etc), two week (Acuvue Oasys), and daily disposable (CIBA Dailies, Acuvue 1-day, etc)
  • Also available for astigmatism and patients over 40 who need reading glasses (more information in my post All Kinds of Blurry)

Daily disposable lenses are the healthier option for your eyes for the simple reason that a fresh, sterile lens is being used every single time. Most infections are a result of poor storage or lens care. A lot of these problems can be avoided with daily lenses.

Rigid Gas Permeable (RGP):AKA Hard lenses. Considered older technology but actually provide better optics, better oxygen flow, and less infections. Less popular simply because they are uncomfortable to begin with. But patients who get used to them, stick to them.

 

Hybrid Lenses:Combination of a hard lens with a soft "skirt". Supposed to provide superior vision of RGPs without being as uncomfortable. But, they haven't been as successful as expected.

Orthokeratology (Ortho-K):Contact lenses that are worn while you sleep. Over night, they flatten the cornea and temporarily correct near-sightedness. Also mentioned in my post Laser Eye Surgery.

Important things to REMEMBER: No matter how good a contact lens claims to be at allowing oxygen pass, or keeping your eyes hydrated, or preventing bacteria from sticking to it, at the end of the day it is still a piece of plastic in your eye.

Contact lenses are considered to be medical devices and, as such, should be looked at by a doctor before they are dispensed and any time the patient experiences any problems.

Three big NOs:

  • No sleeping
  • No swimming
  • No tap water

These are the quickest ways to cause infections which can be potentially vision threatening (see picture below).

Other uses:Contact lenses are not only used to improve vision. Here are a couple of other interesting uses:

  • Diabetic patients
    • Lens changes colour when sugar levels in tears increase
  • Bandage
    • Used to cover scratched corneas or after LASIK surgery
  • Administer drugs over long periods of time
  • Tracking eye movements in ocular studies

FAQ:

Q: Can I get coloured contact lenses even if I have no prescription?

A: Yes. But FYI, these lenses tend to be the least healthy for your eyes.

Q: How often should I replace my contact lens case?

A: Usually every 3 months or when your solution runs out. Whichever comes first.

Q: If I wear contact lenses, do I still need a pair of glasses?

A: Yes, you should always have a good pair of glasses to give your eyes a break and just in case something happens to the contacts.

Q: What if I'm on vacation and I forgot my contact lens solution and my contacts are bothering me and there isn't a pharmacy close by and my cousin says its no big deal, can I just store my contacts in tap water?

A: No. No tap water. Ever. I hope that is clear enough :)