This article is more than 5 years old. Information may no longer be current.
Clean contact lenses reduce risk of papillary conjunctivitis
Click Here to Manage Email Alerts
PITTSFIELD, Mass. — Though contact lens papillary conjunctivitis is not seen very often any more, to keep it that way, practitioners must be careful to instruct their contact lens wearing patients on the importance of maintaining clean lenses, according to John Herman, OD, in private practice here.
"I have pictures of conjunctivitis. As soon as I start mentioning that this is what their lid can look like and that their lens wearing time can be reduced — if not stopped — for quite a while, patients are interested in keeping their lenses clean," he said. "Ninety-nine percent of patients today who come in with papillary conjunctivitis will admit to not taking care of their lenses properly."
Clean lenses key to prevention
"The reason we don't see papillary conjunctivitis too often now is we're into more frequent replacement of lenses and disposable lenses," said Rodger T. Kame, OD, in private practice in Los Angeles.
"It's an exposure problem. It has a mechanical basis and an autoimmune response," he added. "You can use mast-cell stabilizers to control it, but the basis for it is a dirty lens."
Dr. Herman noted that if patients simply do not comply with the lens cleaning regimen, disposable lenses are one way to avoid the disorder. However, disposable lenses are not always the perfect solution.
"There are some prescriptions for which you can't get disposable lenses, and there are, perhaps, a small amount of people who wouldn't see as well as in their current lenses. But 95% of those who you would want to change would be very amenable to it," Dr. Herman said.
According to Dr. Herman, the incidence of the disorder is now about 1% of all contact lens wearers. But in the late 1970s, when he conducted studies seeking to understand the cause, the incidence was approximately 15%.
"It was the number one reason for contact lens failure in soft lenses," Dr. Kame said. Patients simply waited until they had a problem before seeking help instead of following a cleaning regimen.
"Once you're exposed to the antigen — which is denatured protein on the lens — and the problem starts, it snowballs," he said.
Enzyme cleaner developed
"What we initially found in our studies was due to dirty lenses," Dr. Herman explained. "When we discovered what type of film was on the lens that was irritating the lid, companies developed an enzyme cleaner to get it off. The film on the lens was simply normal protein secreted by the eye.
"In people with an allergic nature, more of it was secreted, so there was a variable in the population," he said. Consequently some wearers could go for a far longer time with no symptoms than could others, he noted.
"I had a patient who had a pair of lenses for 10 years," Dr. Kame said. "Most people would have to change these lenses every 1 to 2 years. But she does something right and her tear chemistry compatibility is there. And she's just starting to get some papillary conjunctivitis. That's a rather exceptional response."
The film, nevertheless, does develop and can cause discomfort. "When you look at it under high magnification, it looks almost like sandpaper. It was simply acting as an irritant. Ultimately you get a reaction," Dr. Herman said.
For Your Information:
- John Herman, OD, can be reached at 217 South St., Pittsfield, MA 01201; (413) 499-3797; fax: (413) 499-3834. Dr.Herman has no direct financial interests in the products mentioned in this article nor is he a paid consultant for any companies mentioned.
- Rodger T. Kame, OD, can be reached at 250 E. First St., Ste 802, Los Angeles, CA 90012; (213) 628-7419; fax: (213) 620-9110. Dr. Kame has no direct financial interests in the products mentioned in this article nor is he a paid consultant for any companies mentioned.