Contact Lens-induced Papillary Conjunctivitis Research Articles

Allergic manifestations of contact lens wearing.

Contact lens-induced papillary conjunctivitis (CLPC) is a common ocular allergic disease in contact lens wearers. In its more severe form, it can cause giant papillary conjunctivitis, resulting in contact lens intolerance and the need to discontinue the use of contact lenses. This review presents the pathogenesis, clinical manifestations and management guidelines of this common disorder. Different types of contact lenses are associated with differences in the severity of CLPC. Refitting patients with silicone hydrogel contact lenses or with daily disposable contact lenses may improve the signs and symptoms of CLPC. The recent introduction of the topical immunomodulatory agent tacrolimus in other severe allergic eye diseases may apply in suppressing the allergic inflammation in CLPC as well. CLPC is a common ocular disorder in contact lens wearers, with a significant impact on the quality of vision. It should be promptly recognized by healthcare practitioners and managed by modifications of the types and wearing schedules of contact lenses, as well as novel treatment options with topical immunomodulators.

Risk Factors for Contact Lens–Induced Papillary Conjunctivitis Associated With Silicone Hydrogel Contact Lens Wear

Contact lens-induced papillary conjunctivitis (CLPC) continues to be a major cause of dropout during extended wear of contact lenses. This retrospective study explores risk factors for the development of CLPC during extended wear of silicone hydrogel lenses. Data from 205 subjects enrolled in the Longitudinal Analysis of Silicone Hydrogel Contact Lens study wearing lotrafilcon A silicone hydrogel lenses for up to 30 days of continuous wear were used to determine risk factors for CLPC in this secondary analysis of the main cohort. The main covariates of interest included substantial lens-associated bacterial bioburden and topographically determined lens base curve-to-cornea fitting relationships. Additional covariates of interest included history of adverse events, time of year, race, education level, gender, and other subject demographics. Statistical analyses included univariate logistic regression to assess the impact of potential risk factors on the binary CLPC outcome and Cox proportional hazards regression to describe the impact of those factors on time-to-CLPC diagnosis. Across 12 months of follow-up, 52 subjects (25%) experienced CLPC. No associations were found between the CLPC development and the presence of bacterial bioburden, lens-to-cornea fitting relationships, history of adverse events, gender, or race. Contact lens-induced papillary conjunctivitis development followed the same seasonal trends as the local peaks in environmental allergens. Lens fit and biodeposits, in the form of lens-associated bacterial bioburden, were not associated with the development of CLPC during extended wear with lotrafilcon A silicone hydrogel lenses.

Ocular complications of soft contact lens wearers in a tertiary eye care centre of Nepal

To determine the prevalence and the major types of ocular complications related with soft contact lenses (CL) in a tertiary eye care centre of Nepal. Medical files of 4064 soft CL wearers who started wearing CL between January 2003 and December 2010 in BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS) Kathmandu, Nepal, were retrospectively reviewed. Records of patients who visited the hospital with complications were analyzed. Patients with ocular complications non-related with CL wear were excluded. Complications were found in 4.9% of the total soft CL wearers. Contact lens induced papillary conjunctivitis (CLPC) was the most common complication, comprising 36.9% of the total patients with complications. The other commonly found complications were superior punctuate keratitis (SPK) in 16.2%, conjunctivitis in 18.2%, meibomian gland dysfunction (MGD) in 8.6%, contact lens induced peripheral ulcer (CLPU) in 4%, corneal vascularization in 3.5% and microbial keratitis in 3%. The average time of first occurrence of complications after starting of contact lens wear was 14.3±11.4 months. CLPC, conjunctivitis and SPK were the most common types of soft CL related complications found in Nepal. Vision threatening complications like microbial keratitis was also found in some patients. Patient education in CL hygiene, after care schedule and frequent follow up examinations may help to minimize CL related complications.

Comparison of Tacrolimus, Fluorometholone, and Saline in Mild-to-Moderate Contact Lens-Induced Papillary Conjunctivitis

The purpose of this study was to compare the efficacy of tacrolimus, fluorometholone, and saline in the treatment of mild to moderate contact lens-induced papillary conjunctivitis (CLPC). This was a double-masked, randomized pilot study. A total of 18 soft contact lens users (n = 36 eyes) with mild to moderate papillary conjunctivitis were enrolled. Subjects were randomly assigned into three groups to receive tacrolimus 0.05%, fluorometholone 0.1%, or saline (sodium chloride 0.9%). Drugs were prescribed at the baseline visit (visit 1) and instilled twice daily for 4 weeks. Follow-up visits were taken at week 1 (visit 2), week 2 (visit 3), week 4 (visit 4, drug usage suspended at this visit), and week 6 (visit 5, 2 weeks after interrupting eye drops). Contact lens use was discontinued during the 6 weeks of the study, and variables assessed were symptoms and signs, tear film status, and intraocular pressures. Conjunctival impression cytology was performed at baseline and visit 5 to assess ocular surface status. Mean roughness and redness scores decreased significantly from visit 1 to visit 5, but the variation tendency was comparable in all groups (P = 0.180 and 0.889, respectively). Subjective symptom parameters were improved in all CLPC patients at visit 5, and there was no remarkable difference in symptom reduction in three groups. The mean Schirmer value and mean break-up time (BUT) did not change significantly in the three groups during the study. Ocular surface findings by impression cytology improved significantly after three treatments. Intraocular pressure fluctuation from baseline to 6-week follow-up was not statistically significant in all subjects. No adverse treatment-related event was observed in any study group. Tacrolimus 0.05% may be a safe and effective treatment for mild to moderate CLPC and is comparable with fluorometholone 0.1% in efficacy. Contact lens cessation accompanied with saline may also be effective in treating mild to moderate CLPC.

Prevalence of contact lens related complications in a tertiary eye centre in India

To determine the prevalence of contact lens related complications in a tertiary eye care centre in India. A retrospective review of the charts of 1255 patients who visited our contact lens clinic during 2001-2004 was conducted. The inclusion criteria included patients of at least 18 years of age, having refractive errors and keratoconus. Exclusion criteria included previous corneal surgeries and pediatric patients. 190 subjects with lens related complications were identified from among 923 patients who were using lenses. The prevalence of contact lens complications was 20.58%. Females with complications were more common (59.47%). The complications were more common in students. The most common complications were contact lens induced papillary conjunctivitis (CLPC) (6.39%), corneal vascularisation (4%), and superficial punctate keratitis (SPK) (3.5%). The total complications were less prevalent in patients wearing rigid gas permeable (RGP) lenses as compared to soft contact lenses. Infectious keratitis was noted in 8 eyes. Pseudomonas aeuroginosa was the most common organism isolated. The average daily wear with RGP lenses was 11.04±3.7h and 10.96±3h with soft contact lens. The highest number of complications was noted in 47.89% patients who were wearing lenses for excess of 11h. The number of patients with complications arising due to sleeping with the lenses was 74 (38.95%). Prevalence of contact lens complications was more in soft contact lens wearers compared to RGP wearers. CLPC was the most common complication followed by vascularisation and SPK.

Comparison of Olopatadine and Fluorometholone in Contact Lens-Induced Papillary Conjunctivitis

The purpose of this study was to compare the efficacy of olopatadine with fluorometholone in contact lens-induced mild to moderate papillary conjunctivitis. A randomized, double-masked study was conducted. Eighty-five (n = 170 eyes) soft contact lens users with mild to moderate papillary conjunctivitis were enrolled. Patients were randomly assigned to three groups to receive olopatadine 0.1%, fluorometholone 0.1%, or both. All drugs were instilled twice daily for 8 weeks. Contact lens use was discontinued during initial 4 weeks of therapy and subsequently patients were prescribed monthly disposable lenses. Patients were followed up every 2 weeks, and variables assessed were symptoms and signs, tear film status, and intraocular pressures. Decrease in ocular redness, itching, and tearing along with improvement in contact lens tolerance was comparable in all the three groups. Olopatadine was more effective in reducing redness than fluorometholone at 8 weeks (P=0.01). Improvement in congestion and papillary reaction was comparable in all groups. There was a significant increase in tear break up time of more than 2 sec for fluorometholone and no significant increase for olopatadine. The olopatadine and fluorometholone groups had significant increase of more than 2 mm in Schirmer test and more than 3 sec in tear break up time. In patients with subnormal and borderline tear functions, significant improvement was observed with both drugs. After 8 weeks of use of fluorometholone, there was a significant increase in intraocular pressure (P=0.003). Olopatadine and fluorometholone were the most effective for papillary conjunctivitis followed by olopatadine monotherapy and then fluorometholone monotherapy. Olopatadine is effective in alleviating signs and symptoms of contact lens-induced mild to moderate papillary conjunctivitis and is comparable with fluorometholone in efficacy.

IgE Antibody on Worn Highly Oxygen-Permeable Silicone Hydrogel Contact Lenses From Patients With Contact Lens–Induced Papillary Conjunctivitis (CLPC)

To investigate whether the level of IgE is increased in the eyes of patients during general contact lens-induced papillary conjunctivitis (CLPC) events, which involve enlarged papillae across the entire palpebral conjunctiva, or local CLPC events, in which papillae are confined to one or two parts of the area. Worn contact lenses were collected and soaked in phosphate-buffered saline. The levels of eluted IgE and IgE retained on contact lenses were detected by enzyme-linked immunosorbent assay. IgE was detected in 6 of 12 cases of general CLPC, 8 of 21 cases of local CLPC, and none of 14 control contact lenses. The average level of eluted IgE was 0.54 +/- 1.06 IU/contact lens, 0.28 +/- 0.54 IU/contact lens, and 0.04 +/- 0.06 IU/contact lens for general CLPC, local CLPC, and the control group, respectively. The incidences of positive IgE were significantly higher in patients with CLPC (general and local) than in control subjects, but no statistical difference was found between general and local CLPC. Generally higher amounts of retained IgE were detected on contact lenses that had increased levels of eluted IgE. Contact lenses that were collected before or after a CLPC event did not show increased levels of IgE. The level of IgE is increased in the eyes of some patients during an acute event of CLPC. The similar incidence of IgE-positive cases and levels of IgE from general and local CLPC contact lenses suggest that the conditions may share similar causal pathways.

Prosthetic Soft Contact Lenses in Japan

To investigate the use of the prosthetic iris-tinted soft contact lens, the SEED Opaque, during the past 5 years. The records of 42 outpatients (48 eyes) for whom the prosthetic soft contact lens was prescribed in the contact lens clinic of Juntendo University Hospital from July 2001 to June 2005 were investigated. An investigation was conducted in regard to the tint patterns of the prosthetic soft contact lens and the presence or absence of a transparent part in the middle, as a brown iris with a clear pupil or a solid pupil. The diagnosis, purpose of prescription, age when that lens was prescribed, complications, and changes in corrected visual acuities were analyzed retrospectively from the medical records. The mean age at the first prescription, total number of years of wearing prosthetic contact lenses, total number of prescriptions, and mean period to use each SEED Opaque lens were compared. The mean age at the first prescription of solid-pupil lens wearers was significantly younger than that for clear-pupil lens wearers (P<0.05, Mann-Whitney U test). The solid-pupil type had been prescribed for 30 eyes, all for cosmetic purposes. The clear-pupil type had been prescribed for five eyes for cosmetic purposes and for 13 eyes for improvement of visual function. Complications were shown in 40% of wearers. Contact lens-induced papillary conjunctivitis was highest, followed by punctate superficial keratopathy, superficial punctate keratitis, and corneal erosion. In comparison of corrected visual acuities before and after wearing the clear-pupil cosmetic soft contact lens, significant improvement was observed (P<0.05, paired t test). Although the SEED Opaque lens is a conventional soft contact lens, it is tailor-made for each patient. So it is possible to adjust the color and size of the cosmetic part and the pupil diameter. Further, corrected visual acuities could improve with the clear-pupil type for patients who had prescribed for improvement of visual function.

Two Presentations of Contact Lens-Induced Papillary Conjunctivitis (CLPC) in Hydrogel Lens Wear: Local and General

The purpose of this study was to confirm that two distinct clinical presentations of contact lens-induced papillary conjunctivitis (CLPC), local and general, occur in hydrogel lens wear. Retrospective analyses of 124 CLPC events were identified. The classification of CLPC was based on location and extent of papillae. CLPC was classified as local if papillae were present in one to two areas of the tarsal conjunctiva and general if papillae occurred in three or more areas. The CLPC events were compared with an asymptomatic control group in prospective clinical trials conducted from 1993 until 2003 at two clinical sites, Australia and India. Two hundred sixteen subjects from Australia and 914 subjects from India wore either high Dk silicone hydrogel or low Dk hydrogel lenses on a 6-night (6N) or 30-night extended-wear (EW) schedule. The physiological responses of the ocular surface, including tarsal conjunctiva redness and roughness, number of papillae present, lens fit and performance, and subjective patient symptoms, were measured during each visit at each site. These variables listed were compared between local CLPC groups and asymptomatic controls and general CLPC groups and asymptomatic controls. Two types of CLPC in hydrogel lens wearers have been confirmed. Of the 124 CLPC events, there were 61 local and 63 general events. Local and general CLPC cases reported significantly greater frequency of symptoms compared with the asymptomatic controls, in particular itching, lens awareness, secretion, and blurred vision (p < 0.1). The classification of CLPC into two types, local and general, in hydrogel lens wear was confirmed based on presentations at both sites. This distribution of papillae between local and general CLPC may indicate separate etiologies involved in the pathogenesis of the condition.

Contact lens-induced papillary conjunctivitis is associated with increased albumin deposits on extended wear hydrogel lenses.

Contact lens papillary conjunctivitis (CLPC) may be a combination of immunological and mechanical responses to contact lenses and their deposits, resulting in a hypersensitivity reaction.1 Enlarged papillae on the tarsal conjunctiva, redness, itching, increased mucus, and decreased contact lens tolerance are typical symptoms. 2 CLPC is a major reason for discontinuing contact lens wear; 3 however, the link between lens deposits, mechanical trauma, the immunological response and ultimate discontinuation of lens wear is still unclear. In view of the known immunological aspects of CLPC, our aim was to determine the levels of human serum albumin (HSA), secretory IgA (sIgA, a constitutive protein) and lactoferrin (a regulated protein) on extended wear contact lenses (EWCL).

Contact lenses and tear film interactions.

Contact lenses are a successful form of vision correction. However, under certain circumstances adverse inflammatory responses can occur during lens wear. These inflammatory responses can be divided into those that involve the cornea and conjunctiva, and those that are primarily conjunctival. The former category includes microbial keratitis, contact lens-induced acute red eye, contact lens-induced peripheral ulcers, infiltrative keratitis, asymptomatic infiltrative keratitis and asymptomatic infiltrates. These conditions have recently been described in detail, and many are produced by bacterial contamination of contact lenses.1-4 The major contact lens-related inflammatory conditions primarily associated with the conjunctiva are contact lens-induced papillary conjunctivitis (CLPC), and the more severe form of this disease, giant papillary conjunctivitis (GPC). However, the etiology of these conditions is poorly understood. The aim of the current study is to examine the effect of contact lens wear on tear proteins and determine which and how much specific tear proteins are adsorbed to the contact lens during wear.

Contact lens-induced papillary conjunctivitis is either local or general

Contact lens-induced papillary conjunctivitis is either local or general

Hydrogel contact lens cleaning with or without multi‐enzymes

In a group of 66 daily hydrogel contact lens wearers, all lenses were cleaned and disinfected daily using a regular daily cleaner and a 3% hydrogen peroxide system. In addition, one of the lenses for each subject was subjected to weekly enzymatic cleaning with a multi-enzyme pancreatin preparation. After 6 months there were highly significant differences (P less than 0.001) between the lenses, the enzymatically cleaned ones showing less deposits and longer break-up time (BUT) on the lens. Also, comfort was significantly (P less than 0.05) better for these latter lenses. No adverse reactions that could be attributed with certainty to the preparations used were observed. The effectiveness of the pancreatin preparation employed in this study is of interest, since it has been demonstrated that enzymatic removal of deposits from hydrogel lenses reduces complications such as acute red eye reaction, contact lens-induced papillary conjunctivitis, and presumably also corneal ulceration because of decreased bacterial adherence to the lenses.