Acanthamoeba Outbreaks Among Contact Lens Wearers
In recent years, the U.S. Centers for Disease Control and Prevention and other researchers have noted sporadic outbreaks of Acanthamoeba keratitis cases among contact lens wearers.
In 2007, for example, the CDC released several public health warnings regarding Acanthamoeba keratitis associated with use of the contact lens solution Complete MoisturePlus, manufactured by Abbott Medical Optics formerly Advanced Medical Optics.
The CDC said a sevenfold increase in the risk of developing Acanthamoeba keratitis associated with use of the contact lens solution prompted AMO to withdraw Complete MoisturePlus from the market. The contact lens solution itself was not contaminated, but it seemed to be ineffective in preventing Acanthamoeba keratitis.
The CDC has issued similar warnings concerning fungal eye infections associated with the use of Bausch + Lomb’s ReNu With MoistureLoc contact lens solution, which was removed from worldwide markets in May 2006.
In 2011, the CDC and state and local health officials investigated unusual clusters of Acanthamoeba keratitis cases to find common risk factors to reduce future infections. The preliminary analysis found contact lens hygiene practices played a role but did not result in a call to stop the sales of any contact lens-related products.
Poor Quality Contact Lenses
This one is a little vague, but there is no denying that contact lenses have evolved and improved over the ages. If youre using some relic contact lens from the late 90s or 2000s, its time that you looked into upgrading to something thats better for your eyes.
Nowadays there is a contact lenses designed for almost everybody out there. There are brands with extended ranges to accommodate those with higher prescriptions, brands for people with dry eyes, brands that relax the eye muscles when youre staring at a computer screen, brands that filter out UV light as well as harmful blue light, etc.
With todays selection, theres no reason for you to be stuck in the stone age of contact lenses.
How Do You Know If You Have Acanthamoeba Keratitis
With these types of symptoms, you should always contact your eye doctor. But keep in mind that Acanthamoeba keratitis is often difficult for your eye doctor to diagnose at first, because its symptoms are similar to pink eye symptoms and those of other eye infections.
Diagnosis of keratitis often occurs once it is determined that the condition is resistant to antibiotics used to manage other infections. A “ring-like” ulceration of your corneal tissue may also occur.
Unfortunately, if not promptly treated, Acanthamoeba keratitis can cause permanent vision loss or require a corneal transplant to recover lost vision.
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What Health Care Specialists Diagnose And Treat A Corneal Ulcer
People with a corneal ulcer should be seen by an ophthalmologist.
- Those with the more serious diseases may also need to see an ophthalmologist with cornea expertise.
- If the ulcer is related to an underlying systemic disorder, consultation with your primary care physician and/or a rheumatologist may be indicated.
What Is The Prognosis Of A Corneal Ulcer
The prognosis for a corneal ulcer depends on its cause, its size and location, and how rapidly it is treated together with the response to treatment. Although most corneal ulcers will cause some degree of scarring, the scar will often not cause any visual loss. If the ulcer is deep, dense, and central, scarring will cause some permanent changes in vision.
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Treatment Of Corneal Ulcers
After examination of the eye, the eye care professional will determine what type of treatment is needed. If the corneal ulcer was caused by bacteria the doctor will likely prescribe a topical antibiotic for the eye. Culture of the eye drainage may be taken for further examination. If the doctor suspects a fungal infection topical anti-fungal medication may be needed. If the corneal ulcer is severe, oral agents may also be prescribed.
Your Contact Lenses Are In The Wrong Eye
Inserting your right contact lens into your left eye, and vice versa may not cause physical irritation to your eyes, but can certainly cause visual irritation and headaches.
Typical symptoms of wearing your contact lenses in the wrong eye are strained vision, blurry vision, and headaches.
Once you lose track of which contact lens goes in which eye, it can get a little confusing, especially if the prescription in both of your eyes is very similar.
If all hope is lost and you feel like youve tried wearing every combination, start from scratch and start a new pair of contact lenses. Just make sure that your boxes are properly labeled with Left and Right.
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Risk With Contact Lenses
A special note for contact lens wearers: contact lenses do carry a risk of eye infection, and this risk can be reduced by following professional lens care guidelines.
Extended wear of lenses, dryness, dusty/dirty environments, and poor hygiene all contribute to an increased risk of infection, which, if serious enough, can cause permanent vision problems or an inability to wear contact lenses in the future.
Make sure to replace lenses and storage cases frequently, do not reuse solution or use expired solution, store contacts in disinfecting solutions, not saline, and avoid contact with water while wearing your lenses.
Never wear contact lenses that were not prescribed by an eye care professional.
Contact Lenses At Richmond Eye Associates
Contact lenses provide an alternative to glasses to correct refractive errors such as nearsightedness, farsightedness, astigmatism, and the need for reading glasses. Contact lens technology continues to improve, and newer lenses are available which are often more comfortable to wear, are safer, and may provide clearer vision.
However, contact lens use is not without risk, and it is important to be appropriately fitted for the lenses, with detailed instruction on how to handle and care for the lenses. Donald Lumpkin, O.D. is an optometrist with Richmond Eye Associates who specializes in the fitting and care of contact lenses. He performs fittings for individuals of all ages, from teenage to older adults. Dr. Lumpkin uses a wide variety of contact lenses to provide correction for even more challenging cases, such as high levels of astigmatism and the need for bifocal contact lenses.
Dr. Lumpkin accepts many vision plans and insurances, and sees patients at all of the Richmond Eye Associates offices, including Innsbrook, Midlothian, and Mechanicsville.
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Sleeping With Contact Lenses
Do you sleep with your contacts lenses in? Unfortunately, the more you wear your lenses, the less permeable they will be and the dirtier they will become. Did you know that lenses that are no longer able to breathe oxygen are more likely to lock in dirt and grime and other irritants that can affect eye health?
Sleeping with contact lenses in is the most common cause of this issue. While you may be tempted to sleep with your lenses in after a long day, its important that you take the time to remove and clean them, thus giving your eyes a well-deserved break and preventing irritation.
Disposable Contact Lens Use
Disposable contact lenses can be a useful option for some contact lens users, and there seems to be a trend toward increased use of this type of lens. Even disposable lenses that are discarded on a daily basis are available, although most people use the type of lens that is discarded after 2 weeks. Some reasons and situations for which disposable lenses may be useful include:
- Rapid deposit formation on lenses, with or without the development of giant papillary conjunctivitis.
- Having to replace contact lenses frequently, whether it be because of lens deterioration, damage, or the losing of lenses.
- Sensitivity to solutions used to clean or disinfect lenses.
- Difficulty in finding another type of lens that is equally comfortable for an individual.
Some problems associated with disposable lenses include:
There are definite situations where disposable lenses are appropriate, and some situations where they should be avoided. Exercising caution with the use of any contact lens helps to prevent complications.
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How Is Keratitis Diagnosed And Treated
Keratitis can sometimes cause serious vision loss or even blindness, so it is important to see an optometrist if you are experiencing the above symptoms. Fungal keratitis is treated with topical and oral antifungal medications. Patients who do not respond to medical treatment may require eye surgery, possibly including a corneal transplant.
A corneal ulcer is an erosion or exposed sore on the surface of the cornea. Corneal ulcers are most commonly caused by germs. Other causes of corneal ulcers include viruses, injury and inadequate eyelid closure. Corneal ulcers are common in people who wear contact lenses, especially if they wear them overnight.
Ulcerative Keratitis Is A Sight
Robert A. Ryan, O.D.
|Culture positive Pseudomonas aeruginosa central ulcer with marked inflammation of anterior segment and lids.|
Is it Infectious?
|Contact lens peripheral ulcer , which respects clinical criteria for non-sight-threatening infiltration. Note location and very focal involvement.|
Staphylococcus speciesStaphylococcus aureus
|Microbial keratitis with central ulcer and marked stromal loss. Cyanoacrylate glue forestalls perforation note hypopyon suggesting infectious etiology.|
With increasing therapeutic privileges, scope of practice and patient desire for more convenient means for visual correction, so comes a commensurate intensification of professional responsibility. We must arm ourselves with sharp diagnostic skills and be confident in our treatment protocols to provide competent, full-scope care to our patients. What better way to create patient loyalty and practice vitality in these challenging times?Dr. Ryan is in group practice in Rochester, N.Y., and is clinical associate in ophthalmology at the University of Rochester School of Medicine. He frequently lectures and publishes on anterior segment topics, actively participates as an FDA clinical investigator for many contact lens manufacturers and provides consultative services.
What Causes Corneal Ulcers
To understand what causes corneal ulcers, you have to understand what prevents them.
What prevents most of the body from infection is our blood, which provides nutrients, removes wastes, and provides defense against infection. Blood contains white blood cells that function as the defenders of the body. If you get a cut in your skin, and bacteria or fungi get in past the surface, they will be killed quickly by white blood cells and other such defense systems present in the blood.
The cornea is an extremely unique part of the body. It is completely transparent and clear, which allows it to focus light into the eye. It has no blood flow since blood vessels would make it opaque. The cornea is nourished by a clear fluid inside the eye, which can be thought of as hyper-filtered blood. Due to the lack of blood flow and hence low numbers of white blood cells, if bacteria or fungi get into the cornea there are minimal defenses to kill them. In other words, the cornea is almost a safe haven for these infectious agents. So much for them to eat , without much to kill them.
Your tears also provide defense from infection. Tears lubricate the epithelium and keep it healthy so it doesnt break down. Tears also have special molecules in them that help to control and kill infectious agents. Dry eye conditions, therefore, increase the risk of ulcers.
Chronic Dry Eye Syndrome
Dry eyes are another common problem that contact lens wearers have. Contact lenses require a significant amount of lubrication on the surface of the eye in order to remain in place and hydrated. Commonly, without lubrication these lenses can end up sticking to the surface of the eye as they suck up all the tears that the eye produces. The result? Irritated and red eyes. The effects of this can become worse if the contact lens wear also suffers from chronic dry eye syndrome. This is a condition in which the eyes are not able to produce enough tears.
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Find Relief For Your Eyes Irritated From Contacts
Make sure that you follow the best practices for cleaning, storing and replacement of your contact lenses. You also need to make frequent check-up visits with your optometrist in order to preserve your vision.
These tips will stop your eyes from getting irritated when you use your contacts. If you have any more concerns, your eye doctor can answer any questions you have about your eye comfort. In the meantime, before your next appointment, check out the different contact lens options available. This way you can be fully prepared to start a discussion with your eye care professional.
Presenting Symptoms Of Contact Lens Related Corneal Ulcer
The presenting symptoms of corneal ulcers vary from patient to patient depending on the severity of the ulcer and also how soon the patient seeks treatment. Early symptoms include eye discomfort, foreign body sensation, swollen eye lid and watering of the eyes. More serious symptoms are redness , severe pain, photophobia, eye discharge and blurring of vision. Hypopyon may occur in severe cases and if patient presents late to the clinic.
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What Medications Treat A Corneal Ulcer
- Because the infection is a common occurrence in corneal ulcers, your ophthalmologist will prescribe antibiotic eyedrops. If the infection appears very large, you may need to use these antibiotic drops as often as one drop an hour, even throughout the night. Some patients require more than one type of treatment and some require eyedrops that are compounded at specialty pharmacies or in hospitals.
- Prescription pain medications are not usually required. Over-the-counter acetaminophen or ibuprofen may be used to help with the pain. Some people may find pain relief with eye drops that keep your pupil dilated .
- Steroid eye drops may also be indicated.
Corneal Ulcer Home Care
Your doctor may also recommend some steps you can take at home to ease symptoms:
- Put cool compresses on your eye. But be very careful to keep water away from your eye.
- Donât touch or rub your eye with your fingers.
- Limit the spread of infection by washing your hands often and drying them with a clean towel.
- Take over-the-counter pain medications such as acetaminophen or ibuprofen.
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How You Can Reduce The Risk Of Getting Acanthamoeba Keratitis
There are several easy ways to greatly reduce the chance of getting this sight-threatening condition and, in fact, any type of contact lens-related eye infection:
Follow your eye doctor’s recommendations regarding care of your contact lenses. Use only products that he or she recommends.
Never use tap water with your contact lenses. The FDA has recommended that contact lenses should not be exposed to water of any kind.
Do not swim, shower or use a hot tub while wearing contacts. If you do decide to wear your lenses while swimming, wear airtight swim goggles over them.
Soak your lenses in fresh disinfecting solution every night. Don’t use a wetting solution or saline solution that isn’t intended for disinfection.
Always wash your hands before handling your lenses.
Always clean your contacts immediately upon removal . To clean your lenses, rub the lenses under a stream of multipurpose solution even if using a “no-rub” solution and store them in a clean case filled with fresh multipurpose or disinfecting solution.
How Serious Is A Corneal Ulcer
Corneal ulcers are very serious because they can severely blur your vision or cause loss of the eye. Some infections are so aggressive that they can eat a hole in the eye in just a few days. One of the most aggressive infectious agents, a bacteria called pseudomonas, causes over 50% of all contact lens-associated corneal ulcers.
If you are able to recover from the initial infection, it may heal with an opaque scar. Corneal scars can distort the corneal shape and harm its focusing ability. A hard contact lens may be able to help in this situation. If the scar is in the corneal center it can block light from coming into the eye and severely distort vision. Visual restoration may require a corneal transplant.
Corneal ulcer with layered inflammatory white blood cells
The corneal ulcer progressed when the patient failed to take their antibiotic drops often enough
Contact lens associated pseudomonas ulcer
The ulcer eventually healed with antibiotic drops
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How Do We Treat Corneal Ulcers
Corneal ulcers are treated with extremely frequent doses of one or more types of antibiotics. The antibiotics can be irritating, but it is crucial to follow your doctors instructions to save the cornea.
As mentioned above, the cornea has no blood flow. That is why your doctor cannot simply give you a pill by mouth to kill the infection. When we take antibiotics by mouth, they get into our bloodstream where the antibiotic is distributed throughout the body to constantly bathe the infected area. Because the cornea has no blood flow, pills will not work. To constantly bathe the infection in antibiotic, you have to do it manually. This is most commonly done with antibiotic eye drops. When you put a drop on your eye, it washes away in just a few minutes. The effect of each drop may last more than just a few minutes since some is absorbed into the cornea.
Unfortunately, the effect with each drop doesnt last long. That is why your doctor will have you take the medications every 5 minutes for the first hour or so to load up the cornea with medication. After the first hour, you will likely be allowed to back off to taking the drops every hour. Your doctor will tell you the necessary instructions specific to your case. In some serious cases, we have successfully treated corneal ulcers with an injection of medication directly into the cornea. Hydrating the tissue as such can help to get a higher concentration of medicine into the cornea quickly.