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Contact Lens-Induced Acute Red Eye(CLARE)

Ehsan Shir Ali Vand(MS Opt)

16th congress of optometryTehran- Iran

August 2013www.optazar.blogfa.com

Definition

- inflammatory eye reaction- Usually unilateral - Redness of limbus- Sterile infiltrative keratitis

Symptoms:

- Redness - Irritation - Mild pain- Photophobia- Watering

sign- Infiltration

- Anterior chamber involvement (-)

- Fluorescein staining (-)

Etiology

- Bacterial contamination- Hypoxia - Tight lens- Deposit

Deposit

- Denatured protein ,calcium ,lipid and…- Mechanical trauma

Bacterial contamination

- Gram negative- Gram positive

Corneal Hypoxia

Examination

- Slit lamp eye examination:- Low mag. Diffuse illumination- High mag. Direct and indirect illumination- Fluorescein staining method

infiltrations

-sterile infiltration

-infectious infiltration

Sterile infiltration

- Contact lens induced peripheral ulcer(CLPU)- Contact lens induced acute red eye(CLARE)- Infiltrative keratitis(IK)

Differential diagnosis

-sterile infiltrations:- CLARE- CLPUC- Infiltrative keratitis(IK)- microbial keratitis(MK)

CLPU

- Unilateral inflammatory reaction- Noticed in morning- Epithelial loss- Anterior chamber involvement- Corneal staining- Watering ,limbal redness ,mild to severe pain ,foreign

body sensation .

Infiltrative keratitis

- Sub epithelial infiltration- Daily occurrence - Burning ,mild pain ,redness- Unilateral inflammatory reaction

Microbial keratitis- Corneal staining more than 2mm in diameter- Focal infiltration more than 1.5mm in diameter- Severe ocular pain that persist or worsens after lens removal- Extensive anterior chamber flare- Significant vision loss

prognosis

- Discomfort- Photophobia- Infiltration- Vision loss

Management

- Cease lens usage - Improve hygiene- Fit frequent replacement lens- Fit low water content lens- Avoid tight lens fit

Thank you for your attention