Papillary conjunctivitis

Efron, Nathan

doi:10.1016/b978-0-7020-4269-0.00012-2

Cited by 2 publications

(2 citation statements)

References 36 publications

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“…Perhaps the only circumstance that can alter lens fit significantly is the development of ocular pathologies which alter the physical characteristics of the anterior eye. For example, soft lenses tend to exhibit greater movement with blinking in the presence of papillary conjunctivities or dry eye, and a pterygium or pinguecula may affect the movement of a rigid lens . Accordingly, in respect of lens performance, the suggested aftercare frequency should be aligned to that recommended in relation to ocular health considerations, as discussed above.…”

Section: Preserving Ocular Healthmentioning

confidence: 99%

Rethinking contact lens aftercare

Efron

Morgan

2017

Clinical and Experimental Optometry

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The evolution of contact lens technology and clinical practice over the past three decades has been remarkable, with dramatic improvements in material biocompatibility, better lens designs and care systems, and more flexible and convenient modalities of wear. However, our approach to the aftercare examination has remained conservative, with the general modus operandi having not fully evolved from the difficult, early years of fitting non-regular replacement rigid and low water content hydrogel lenses. In this paper, we review current aftercare practice and in particular, the preferred frequency that lens wearers should return for routine visits and the appropriateness of regulations governing contact lens prescription expiry. Four key clinical reasons for conducting a routine aftercare visit are identified: preserving ocular health, maintaining good vision, optimising comfort and ensuring satisfactory lens fitting performance. Commercial reasons for conducting aftercare visits are also considered. A decision matrix is presented to help practitioners decide on an appropriate time interval between routine aftercare visits. The first aftercare visit should always take place within one to two weeks of lens dispensing. After this, the following time intervals between routine aftercare visits are advised as a general guideline: soft daily disposable, 24 months; soft daily reusable and rigid daily wear, 12 months; soft and rigid extended wear, six months. These aftercare visit frequencies may need to be adjusted when rapid rates of refractive change are anticipated, such as every six months during child/teenager myopic progression and every 12 months during the advancement of presbyopia. Numerous clinical caveats for varying these recommended aftercare frequencies are also discussed. Those new to lens wear should be seen within the first two months of lens dispensing. Regulatory authorities charged with the responsibility of stipulating the validity of a contact lens prescription should continue to allow optometrists to set an expiry date relevant to the circumstances of individual lens wearers.

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Section: Preserving Ocular Healthmentioning

confidence: 99%

Rethinking contact lens aftercare

Efron

Morgan

2017

Clinical and Experimental Optometry

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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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confidence: 99%

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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Papillary conjunctivitis

Cited by 2 publications

References 36 publications

Rethinking contact lens aftercare

Rethinking contact lens aftercare

Contact lens wear is intrinsically inflammatory

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