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Lid eversion, fluorescein can reveal dislocated contact lenses
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Doctors found a hard mass of 17 contact lenses bound by mucus in a 67-year-old woman who presented for cataract surgery.
The case report was published in the British Medical Journal.
During peribulbar anesthesia, a bluish foreign body emerged from the superior fornix as the mass of 17 contact lenses. The surgeon found 10 additional lenses during examination under a microscope.
The patient had worn monthly disposable contacts for 35 years.
Researchers reported that she had poorer vision in the right eye and deep-set eyes, which may have contributed to the unusually large number of retained foreign bodies.
“This case highlights the importance of appropriate candidate selection and monitoring of contact lens wearers,” researchers wrote.
Double lid eversion and fluorescein staining of the ocular surface can reveal dislocated contact lenses in the upper fornix, they concluded. – by Abigail Sutton
Disclosures: Please see the journal for all financial disclosures.
Perspective
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Walter L. Choate Jr., OD, FAAO
This is a recently reported case of a woman from Great Britain presenting for cataract surgery and having 17 to 27 contact lenses discovered in the upper fornix by the anesthesiologist on the day of surgery.
As funny and preposterous as this case seems to be, it should serve as a wake-up call to all of us in practice to not become lax in our follow-up care of contact lens patients. How this was not discovered at least in the surgical work-up is strange at best.
Every contact lens patient should be worked up for suitability to even wear contact lenses and any trace of ocular surface disease treated before fitting. The lens replacement schedule, wear schedule and contact lens care system should be tailored to each individual’s needs. Too often, many colleagues fall into the trap of fitting the patient to the available contact lens and not customizing solutions for each patient.
Proper follow-up care should include at least one visit annually for maintenance care. That visit should always include corneal mapping, evaluation for developing dry eye and allergy, re-evaluation of the fit, over-refraction and lid eversion.
Giant papillary conjunctivitis had almost disappeared in our practice until silicone hydrogels emerged. Now lid eversion uncovers many issues with lid pathology that will not be seen without it.
Certainly, that one simple procedure would have improved the care for this unfortunate lady.
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