Corneal infiltrative events

Efron, Nathan

doi:10.1016/b978-0-7020-4269-0.00024-9

Contact Lens Complications 2012

DOI: 10.1016/b978-0-7020-4269-0.00024-9

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Corneal infiltrative events

Nathan Efron

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2017

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“…At the outset, I need to introduce an important point of clarification: I am not referring here to frank, overt inflammatory reactions to contact lens wear, such as papillary conjunctivitis, superior limbic keratoconjunctivitis, microbial keratitis or even the various forms of corneal infiltrative events . The proposition I am advancing is that normal, asymptomatic, problem‐free contact lens wear (aside from ‘end of day discomfort’, which all lens wearers experience) is intrinsically inflammatory.…”

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Contact lens wear is intrinsically inflammatory

Efron

2017

Clinical and Experimental Optometry

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Eye-care practitioners typically associate ocular inflammation during contact lens wear with serious complications such as microbial keratitis; however, more subtle mechanisms may be at play. This paper tests the notion that contact lens wear is intrinsically inflammatory by exploring whether uncomplicated contact lens wear meets the classical, clinical definition of inflammation -rubor (redness), calor (heat), tumor (swelling), dolor (pain) and functio laesa (loss of function) -as well as the contemporary, sub-clinical definition of inflammation (cellular and biochemical reactions). It is demonstrated that all of these clinical and sub-clinical criteria are met with hydrogel lens wear and most are met with silicone hydrogel lens wear, indicating that uncomplicated contact lens wear is intrinsically inflammatory. Consideration of both traditional and contemporary thinking about the role of inflammation in the human body leads to the perhaps surprising conclusion that the chronic, low grade, sub-clinical inflammatory status of the anterior eye during contact lens wear, which may be termed 'para-inflammation', is a positive, protective phenomenon, whereby up-regulation of the immune system, in a non-damaging way, maintains the eye in a state of 'heightened alert', ready to ward off any extrinsic noxious challenge. Characterisation of this inflammatory status may lead to the development of lens engineering or pharmacological strategies to modulate contact lens-induced inflammation, so as to render lens wear more safe and comfortable.Key words: conjunctiva, cornea, contact lens wear, inflammation, para-inflammationThe topic that I have chosen to present in this H Barry Collin Research Medal Lecture a is a question that has been niggling away at the back of my mind throughout my career. To illustrate this, I draw your attention to a paper I published in 1985 entitled 'Is contact lens-induced corneal oedema inflammatory?' 1 and a follow-up editorial published over a quarter of a century later entitled 'Is contact lens wear inflammatory?' 2 Although the title of the present paper gives away the conclusion that I have ultimately reached, the thought process that has evolved over the past 30 years, supported by emerging evidence rooted in clinical practice and fundamental vision science, is a story worth telling.The notion that inflammation is an intrinsic component of normal, asymptomatic contact lens wear has emerged in part because it has not been possible to otherwise explain some of the most fundamental problems relating to contact lens wear -in particular discomfort, which invariably worsens toward the end of the day.3 If it can be established that contact lens wear is inflammatory, this would open up the door for the exploration of a raft of engineering solutions by way of lens material formulations and designs, as well as pharmacological strategies that can modulate the inflammatory response. At the outset, I need to introduce an important point of clarification: I am not referring here to frank, overt inflammato...

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confidence: 99%

Contact lens wear is intrinsically inflammatory

Efron

2017

Clinical and Experimental Optometry

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Corneal infiltrative events

Cited by 1 publication

References 58 publications

Contact lens wear is intrinsically inflammatory

Contact lens wear is intrinsically inflammatory

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