Corneal pathophysiology with contact lens wear

doi:10.1016/0039-6257(90)90046-X

Survey of Ophthalmology

Volume 35, Issue 1, July–August 1990, Pages 25-58

https://doi.org/10.1016/0039-6257(90)90046-X Get rights and content

Abstract

Contact lens wear induces a wide spectrum of changes in the appearance and function of the cornea. The most salient effect of lens wear is the hypoxically induced reduction in the rate of metabolic activity of the corneal epithelium and its sequellae. Other important alterations to corneal health associated with contact lens wear may be caused by antigenic and toxic stimuli, mechanical forces, osmotic effects and carbon dioxide retention. Perhaps the most important task facing the contact lens clinician is to distinguish between an acceptable state of physiological modification and an anomalous or pathological state of hypofunction. In this article, we review the assortment of corneal changes primarily on the basis of the causative agents and time scale with reference to the physical and chemical processes leading to the observed signs or symptoms. This procedure allows a strong foundation for understanding the etiology and management principles for the variety of effects that contact lenses may have on the cornea.

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Cited by (115)

A refined model on flow and oxygen consumption in the human cornea depending on the oxygen tension at the interface cornea/post lens tear film during contact lens wear
2022, Journal of Optometry
Citation Excerpt :
For prolonged contact lens wear and lower diffusive of oxygen into the cornea persist hypoxia and hypercapnia are present, this causes retardation of the normal carbon dioxide efflux, and then corneal acidosis promotes endothelial polymegethism, epithelial microcysts, corneal edema, striate lines, infiltrative keratitis, neovascularization or limbal hyperemia among others.25 However, CLs with higher transmissibility may overcome some of these complications to promote a healthy cornea and from our point of view, such CLs providing relaxation times lower than 8 s because the amount of oxygen into the cornea is enough to facilitate the normal physiological processes.24–36 Relaxation time in this context represents the inertia of the biological corneal energetic system to adapt to a new changing oxygen environment.
The study of oxygen consumption rate under” in vivo” human cornea during contact lens wear has been technically a challenge and several attempts have been made in the last 20 years to model the physiology of the human cornea during contact lens wear. Unfortunately, some of these models, based on a constant corneal oxygen consumption rate, produce areas on the cornea where the oxygen tension is negative, which has no physical sense. In order to avoid such inconsistency, different researchers have developed alternative models of oxygen consumption, which predict the likely oxygen metrics available at the interface cornea/post lens tear film by determination of oxygen flux, oxygen consumption, and oxygen tension through the different layers (endothelium, stroma, and epithelium). Although oxygen deficiency produces corneal edema, corneal swelling, hypoxia, acidosis, and other abnormalities, the estimation of the oxygen distribution below the impact of a contact lens wear is interesting to know which lens transmissibility was adequate to maintain the cornea and avoid epithelial and stromal anoxia. The estimation of minimum transmissibility for a lens for extended wear applications will be very useful for both clinicians and manufacturers. The aim of this work is to present a complete discussion based on Monod kinetics model that permits give an estimation of oxygen partial pressure distribution, the profile distribution of corneal flux and oxygen consumption rate, and finally the estimation of the relaxation mechanism of the cornea depending on the oxygen tension at the interface cornea/post lens tear film. Relaxation time in this context can quantify the capability of the corneal tissue to adapt to increasing concentrations of oxygen. It is proposed this parameter as a biological meaningful indicator of the interaction between contact lens polymers and living tissues such as the corneal cellular layer.
Antimicrobial susceptibility of isolated pathogens from patients with contact lens-related bacterial keratitis in Crete, Greece: A ten-year analysis
2021, Contact Lens and Anterior Eye
Citation Excerpt :
The tear film and the conjunctiva play a major role in preventing the formation of bacterial biofilm, and CLs wearing has been shown to alter the microbiota of the conjunctiva and the physiology of the corneal epithelium [4,5]. These changes render the conjunctiva and cornea susceptible to infection [3–5]. The aim of the study was to evaluate the spectrum of pathogens isolated from corneal scrapings and CLs samples from patients with CL-related bacterial keratitis and determine their susceptibilities to antimicrobial agents.
To evaluate the bacterial spectrum and antimicrobial susceptibilities of pathogens isolated from contact lens-related bacterial keratitis cases in a large academic Greek hospital.
All adult patients with positive corneal scrapings or contact lens culture between 2007 and 2016 at the University Hospital of Heraklion, Greece, were retrospectively identified through a local microbiology database and their medical records were reviewed.
A total of 240 isolates were recovered from 131 patients with culture-proven contact lens-associated bacterial keratitis. The most common microorganism identified was Serratia marcescens (17.1% of total isolates), followed by Pseudomonas aeruginosa, Klebsiella spp. and coagulase-negative staphylococci (CoNS). Rates of aztreonam-resistant P. aeruginosa and erythromycin-resistant CoNS decreased in recent years, while the decrease in oxacillin-resistant CoNS was statistically significant (p=0.009). More than 90% of the isolated organisms (S. marcescens, P. aeruginosa, Klebsiella spp. and CoNS) were susceptible to ciprofloxacin or gentamicin.
Gram-negative microorganisms are the most common causative pathogens of contact lens-related keratitis in the region of Crete. Topical antibacterials containing quinolones or gentamicin represent an effective empirical treatment for the majority of the cases. This is quite encouraging, considering that the present study was conducted in a country characterised by high antimicrobial resistance rates. However, culture-driven antimicrobial treatment is mandatory for this sight-threatening infection.
CLEAR - Effect of contact lens materials and designs on the anatomy and physiology of the eye
2021, Contact Lens and Anterior Eye
This paper outlines changes to the ocular surface caused by contact lenses and their degree of clinical significance. Substantial research and development to improve oxygen permeability of rigid and soft contact lenses has meant that in many countries the issues caused by hypoxia to the ocular surface have largely been negated. The ability of contact lenses to change the axial growth characteristics of the globe is being utilised to help reduce the myopia pandemic and several studies and meta-analyses have shown that wearing orthokeratology lenses or soft multifocal contact lenses can reduce axial length growth (and hence myopia).
However, effects on blinking, ptosis, the function of Meibomian glands, fluorescein and lissamine green staining of the conjunctiva and cornea, production of lid-parallel conjunctival folds and lid wiper epitheliopathy have received less research attention. Contact lens wear produces a subclinical inflammatory response manifested by increases in the number of dendritiform cells in the conjunctiva, cornea and limbus. Papillary conjunctivitis is also a complication of all types of contact lenses. Changes to wear schedule (daily disposable from overnight wear) or lens materials (hydrogel from SiHy) can reduce papillary conjunctivitis, but the effect of such changes on dendritic cell migration needs further study. These changes may be associated with decreased comfort but confirmatory studies are needed. Contact lenses can affect the sensitivity of the ocular surface to mechanical stimulation, but whether these changes affect comfort requires further investigation.
In conclusion, there have been changes to lens materials, design and wear schedules over the past 20+ years that have improved their safety and seen the development of lenses that can reduce the myopia development. However, several changes to the ocular surface still occur and warrant further research effort in order to optimise the lens wearing experience.
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2019, Contact Lenses
Contact Lens Complications
2018, Contact Lens Complications
Soft Lens Design and Fitting
2018, Contact Lens Practice

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Major reviewCorneal pathophysiology with contact lens wear

Abstract

A treatise on hydrophilic lens induced superior limbic keratoconjunctivitis

Int Contact Lens Clin

Corneal ulcers in patients with cosmetic extended-wear contact lenses

Am J Ophthalmol

Neovascularization — how much and how far?

J Am Optom Assoc

Corneal deswelling response to hard and hydrogel extended wear lenses

Invest Ophthalmol Vis Sci

Carbon dioxide permeability of contact lens materials

Int Contact Lens Clin

Temporary changes in the ocular refractive system caused by contact lens wear

Contacto

The correlation of visible corneal ocdema with corneal thickness change

Int Contact Lens Clinic

Corneal endothelial response to rigid contact lenses

Am J Optom Physiol Opt

Flatter than “K,” on “K,” Steeper than “K,” does the cornea know the difference?

Am J Optom Physiol Opt

Adherence of Pseudomonas to soft contact lenses and cornea: Mechanisms and prophylaxis

Models for the specific adhesion of cells to cells

Science

Extended wear of oxygen permeable rigid lenses in aphakia

Int Contact Lens Clin

Continuous wearing of a soft contact lens

Int Contact Lens Clin

The effect of rigid gas permeable lenses on corneal sensitivity

J Am Optom Assor

Histopathological analysis of the corneal epithelium after contact lens wear

J Am Optom Assoc

Corneal response to rigid contact lens wear

Br J Ophthalmol

Epithelial morphological response to soft hydrogel contact lenses

Br J Ophthalmol

Extended wear silicone lenses in aphakia

Contact Intraocular Lens Med J

Contrast sensitivities through spectacles and soft contact lenses

Am J Optom Physiol Opt

Keratoconjunctivitis and soft contact lens solutions

Arch Ophthalmol

Silicone extended wear lenses

Contact Intraocular Lens Med J

Contact lens induced keratopathy: A severe complication extending the spectrum of keratoconjunctivitis in contact lens wearers

Ophthalmology

Experience in clinical examination of corneal sensitivity

Br J Ophthalmol

Corneal epithelial permeability and daily contact lens wear as determined by fluorophotometry

Curr Eye Res

Management of infections associated with soft contact lens

Ophthalmology

Central and peripheral corneal swelling accompanying soft lens extended wear

Am J Optom Physiol Opt

Corneal acidosis during contact lens wear: Effects of hypoxia and carbon dioxide

Invest Ophthalmol Vis Sci

Effect of rigid contact lens oxygen transmissibility on stromal pH in the living human eye

Ophthalmology

Measurement of in vivo human corneal stromal pH: open and closed eyes

Invest Ophthalmol Vis Sci

Corneal aesthesiometry: Its measurement in the dark

Am J Optom Arch Am Acad Optom

Use of air to decrease endothelial cell loss during intraocular lens implantation

Arch Ophthalmol

Patterns of lens care practice and lens product contamination in contact lens associated microbial keratitis

Contact Lens Assoc Ophthalmol J

Corneal response to thick and thin hydrophilic lenses

Am J Optom Physiol Opt

Circinate pattern interstitial keratopathy in daily wear soft contact lens wearers

Arch Ophthalmol

Optimizing the thickness-water content relationship for hydrogel lenses

Contact Lens Assoc Ophthalmol J

Critical oxygen requirements to avoid oedema of the central and peripheral cornea

Acta Ophthalmol

Corneal oxygen availability during contact lens wear: a comparison of methodologies

Am J Optom Physiol Opt

Oxygen permeability of hard gas permeable contact lens materials

Clin Exp Optom

Methodology for determining the intrinsic oxygen permeability of contact lens materials

Clin Exp Optom

The anterior corneal mosaic

Major review
Corneal pathophysiology with contact lens wear