(December 27, 2007 - Insidermedicine) Welcome to Insidermedicine's If I Had, where we get a chance to ask an expert what they would do if they had a medical condition.
Today, I have the pleasure of introducing Dr. Christopher J. Rapuano, who is Co-Director of the Cornea Service and Co-Director of the Refractive Surgery Department at Wills Eye Hospital. He is also an Associate Professor of Ophthalmology at the Jefferson Medical College of Thomas Jefferson University. In addition to serving as Editor-in-Chief of the journal "Year Book of Ophthalmology", Dr. Rapuano is also the author of one of the most successful books ever published in Ophthalmology, "The Wills Eye Manual".
We asked Dr. Rapuano for his thoughts on what to do if you have a red eye and are a contact lens wearer.
If I had developed a red eye and was a contact lens wearer…
Dr. Rapuano: The first thing you do is to take the contact lens out and if the eye feels much better, and over the next hour or two or three, you know, it’s doing better, it’s not red, it’s not painful, it’s not inflamed, then it’s much less concerning. You don’t have to worry about it, for the most part. If, however, it stays red and inflamed and irritated, then you’ve got to worry that there’s a scratch there with the potential for corneal ulcer, corneal infection, things like that. The first person that you’d see would be probably the person who prescribed your contact lenses. They know you the best and they’ve seen you before and you’ve got a relationship with them. Often that’s an optometrist, or it could be an ophthalmologist.
What should I expect when I go to see an ophthalmologist?
Dr. Rapuano: So, basically, the ophthalmologist needs to do a history, figure out when this started, how long it’s been going on, have you had these episodes before, and things like that. And certainly they need to check your vision and do a slit lamp exam. The slit lamp exam is key because that tells the ophthalmologist basically, for the most part, what’s going on and what to do next. The expected course in a patient who has a contact lens eye problem is that, in general, it starts to get better with whatever treatment you’re getting. If it’s not getting better over the first 24 to 48 hours, you need to be seen right away and get a further workup, and if your doctor is not concerned that things are getting worse and worse, you may need to see another doctor, who may be more experienced or whatever.
What is Acanthamoeba keratitis?
Dr. Rapuano: One of the corneal infections that we’re most concerned about in contact lens wearers is an infection called Acanthamoeba keratitis, which is a rare infection but certainly not unheard of, and it’s from a parasite that gets into the cornea related to contact lens wear. The typical history is a red, irritated eye from contacts which has been going on for days and days and sometimes weeks and weeks, and sometimes you’ve already seen one or two eye doctors who have treated you with one antibiotic or another antibiotic and things just aren’t getting better. Not getting better and maybe even getting worse over several weeks. And again, as I said before, if things are getting worse, you need to go see someone else or have additional workup or have additional treatment. As a cornea specialist, unfortunately I end up seeing patients three, four, five, six weeks after they began with the red eye and now it’s pretty obvious that they have Acanthamoeba keratitis. At that point it’s much more difficult to treat than it would have been if I’d seen them at one week or two weeks.
What are some risk factors for developing corneal infections?
Dr. Rapuano: Risk factors for developing Acanthamoeba corneal infections are basically soft contact lens wear. That’s the biggest risk factor, but millions of people wear soft contact lenses and don’t get into trouble. Which of the soft contact lens wearers are at higher risk? Basically, people who use tap water as part of their disinfecting or cleaning system. They should not be using tap water; they should just be using sterile saline that you buy at the drug store. You want to use a good disinfecting system, and there are several of them out there; UltraCare may be one of the best ones against Acanthamoeba, although none of them are perfect against Acanthamoeba. We think that swimming in contacts increases the risk, using a hot tub with your contacts, and maybe even showering with contacts, which many, many people do, but Acanthamoeba lives all over, including tap water and shower water, and if you get that in your eye, and you’ve already got a little microscopic scratch, it can get in there. One of the best ways to avoid corneal infections, in relation to contact lenses, is to use daily wear disposable contacts. And that’s what we recommend for just about all our patients who are in soft contacts.
Dr. Rapuano: The first thing to do if you’ve got a red eye and you’re a contact lens wearer is take the contact lenses out. If the eye is not feeling much better with the contact lenses out, or feeling worse in the next few hours, you need to see an eye doctor and they need to take a look at your eye and if there is evidence of infection, they need to treat it aggressively, and if there’s evidence of severe infection, culture it and treat it aggressively.