Question about Contacts

[Kovox]

Hi!

Maybe you guys can help me out with this, is there a benefit with using disposable every 2 week contacts versus the 6 month contacts?

I asked my opt but he really did not explain it to me and just said that the 6 month was more convienent.

The reason I am asking this is my eyes were burning really badly for some reason, I doubt it's pink eye (my eyes aren't pink). So my general doc gave me a steroid (tro something) and said to use it 3-4 days. Though I wanted to use it more, I didn't continue to overuse since it's a steroid and could give me Glucoma and well, gotta listen to my doc. So the burning went away but there is still like 2 percent burning. I am going to the Opth this week but just wanted to ask you guys if you think its' due to the contacts and improper cleaning?(More opinions are always good).

I'm pretty sure it's not due to contacts scratching me cuz I don't have blurred vision and I use soft contacts.

I currently use the 6 month throw away contacts.

Haha okay, that's it for now. I hate eye infections, it hurts like hell...grr

[Andrew_Doan]

Hey.

I don't think there is much difference in the 2 weeks vs 6 months; other than the need to buy more contacts with the 2 weeks.

The common causes for a red eye with contact lens use is:

1) Overuse. Take them out to sleep. Contacts make your cornea ischemic and you'll have epithelial changes and inflammation. This is why the steroids helped. Do not over do the steroids either. You'll increase your intraocular pressures and have other complications.. such as masking a real infection.

2) Changing to a cleaning solution with an irritant preservative. Try to use preservative free solutions.

3) Improper fitting of your contacts. If they aren't fitted properly, then this will increase irritation.

4) Improper cleaning of the contact and the container. You need to clean both on a regular basis. Many people don't bother with the container, and when I look in there, there's hair, dirt, and fuzz floating around. Also follow the manufacturer's recommendations for cleaning of the contact.

5) Infection. Contact lens wearers are at higher risk for bacterial keratitis and conjunctivitis.

Go see your ophthalmologist/optometrist to make sure your contacts are fitted properly.

[TomOD]

Ophtho_MudPhud,

Congratulations and thanks for taking the time as moderator of this site. Even though I am an OD and much of the discussion is about Opht. residencies and such, I still enjoy reading your very informative information.

I almost always recommend the silicon/hydrogel contact lens now because I believe they are greatly superior to the standard hydrogel lens of the past (and current). Very high DK/L. The prevailing thought is that within the next 5 years, all soft lenses will be made of the super oxygen permeable S/H material. Currently they are FDA approved as a 30 day continuous wear lens although most of my patients do not wear them that long. I usually recommend a monthly modality (basically because it is easy to remember......change the 1st of each month). In many cases, I think the 2 week modality is overkill except for the cheap lenses (Focus, AV, etc). I think very few eye docs prescribe conventional (yearly or even 6 month) lenses any longer. Cost wise, the disposibles are usually as inexpensive as conventional ones and much more convienent (especially for me).

Anyway, as far as the original poster, I would ask for the S/H (only availble as Focus Day and Night right now because of a patent lawsuit between Ciba and B&L.....no Purevision are allowed to be sold in the US until further notice). They are also great for dry eyes, as an aside.

Sorry for intruding on the Ophthalmolgy site. I do have an interesting case of possible idiopathic uveitic glaucoma with IOP of 51, grade 1 hypehema, grade 2+ -3 C&F in ant chamber (or possible microhyphema/RBC in chamber??), no hx of trauma, 60 y.o., perfect systemic health....... I have been seeing her for 4 days treating heavily topically with mild resolution. She is holding steady and will see the local glaucoma Ophthalmologist tomorrow. Interesting case that has me scratching my head. I don't know if this is place to discuss it but I would love to hear any opinions/insights if interested.

Tom

[Andrew_Doan]

Originally posted by TomOD
Ophtho_MudPhud,

Congratulations and thanks for taking the time as moderator of this site. Even though I am an OD and much of the discussion is about Opht. residencies and such, I still enjoy reading your very informative information.

I almost always recommend the silicon/hydrogel contact lens now because I believe they are greatly superior to the standard hydrogel lens of the past (and current). Very high DK/L. The prevailing thought is that within the next 5 years, all soft lenses will be made of the super oxygen permeable S/H material. Currently they are FDA approved as a 30 day continuous wear lens although most of my patients do not wear them that long. I usually recommend a monthly modality (basically because it is easy to remember......change the 1st of each month). In many cases, I think the 2 week modality is overkill except for the cheap lenses (Focus, AV, etc). I think very few eye docs prescribe conventional (yearly or even 6 month) lenses any longer. Cost wise, the disposibles are usually as inexpensive as conventional ones and much more convienent (especially for me).

Anyway, as far as the original poster, I would ask for the S/H (only availble as Focus Day and Night right now because of a patent lawsuit between Ciba and B&L.....no Purevision are allowed to be sold in the US until further notice). They are also great for dry eyes, as an aside.

Sorry for intruding on the Ophthalmolgy site. I do have an interesting case of possible idiopathic uveitic glaucoma with IOP of 51, grade 1 hypehema, grade 2+ -3 C&F in ant chamber (or possible microhyphema/RBC in chamber??), no hx of trauma, 60 y.o., perfect systemic health....... I have been seeing her for 4 days treating heavily topically with mild resolution. She is holding steady and will see the local glaucoma Ophthalmologist tomorrow. Interesting case that has me scratching my head. I don't know if this is place to discuss it but I would love to hear any opinions/insights if interested.

Tom

Hi Tom,

You're not intruding, and it's wonderful that you can provide insight here too. There are too many contact manufacturers and different materials that I constantly consult the OD staff in my program for advice and direction. You need a physics degree to understand all the mechanics of contact permeability.

In regards to the patient with uveitis, there are several things you need to consider. Anyone can have a single flare-up of idiopathic uveitis, but if it's severe, chronic, non-responsive to therapy, and recurring then there are several things you need to rule-out. You must make sure that's it's only isolated to the anterior chamber and not involving the posterior pole. If there is posterior uveitits, then you need to look at the retina.

If it's strictly an anterior uveitis, then you need to rule-out systemic disorders such as syphillis, TB, sarcoidosis, HLA-B27 arthropathies, Bechet's disease, inflammatory bowel disease (IBD), and lupus. This patient is a little old for lupus. The typical workup is to draw HLA-B27 serology, RPR and FTA-ABS for syphillis, chest x-ray for TB and sarcoidosis, and ask a good review of systems to rule-out skin lesions, arthritis, and systemic manifestations of lupus and auto-immune disorders/IBD.

This case sounds complicated and referral to glaucoma is a wise decision. The intraocular pressure is dangerously high, and need aggressive therapy with steroids and glaucoma medications. She may even need sub-tenons injection of steroid. I bet her trabecular mesh work is plugged up by cells and protein debris. Did she have iris bombe and pupillary block?

Keep me posted on the diagnosis.

[TomOD]

Andrew,

Thanks for the information. I originally saw her last Friday afternoon (always on a Friday). She is a previous pt. with a routine hx. Her chief complaint was "mild irritation and blurry vision in the right eye x 1 day". I question the 1 day part however. Her presenting IOP was 51. This was reduced to 27 mmHg with an alternating gtt of Betoptic and Alphagan every 15 min over the course of about an hour and a half. DFE showed a healthy retina with no holes or tears noted. ON and macula looked great. I did an HRT for future comparison. She is currently on PF q1h (orginally PF q15min x 6hr), Atropine, Betopic-S and Alphagan all bid. If it is not WBC/Protein (classic cells and flare) and instead floating RBC, what is the treatment? I have considered blood work but will leave it to the glaucoma guy. There is a grade 1 hyphema. Gonioscopic view shows blood inf (of course) and also enough blood in the temp and nasal angle to make it impossible to view the angle structures. Other than trauma or neoplasm, I don't know what else would cause that much bleeding. 360 neovascularization??? The big question for me is where is all the blood coming from? Anyway, I know it is tough to make a diagnosis on-line, but I appreciate your help.

[Andrew_Doan]

Originally posted by TomOD
Andrew,

Thanks for the information. I originally saw her last Friday afternoon (always on a Friday). She is a previous pt. with a routine hx. Her chief complaint was "mild irritation and blurry vision in the right eye x 1 day". I question the 1 day part however. Her presenting IOP was 51. This was reduced to 27 mmHg with an alternating gtt of Betoptic and Alphagan every 15 min over the course of about an hour and a half. DFE showed a healthy retina with no holes or tears noted. ON and macula looked great. I did an HRT for future comparison. She is currently on PF q1h (orginally PF q15min x 6hr), Atropine, Betopic-S and Alphagan all bid. If it is not WBC/Protein (classic cells and flare) and instead floating RBC, what is the treatment? I have considered blood work but will leave it to the glaucoma guy. There is a grade 1 hyphema. Gonioscopic view shows blood inf (of course) and also enough blood in the temp and nasal angle to make it impossible to view the angle structures. Other than trauma or neoplasm, I don't know what else would cause that much bleeding. 360 neovascularization??? The big question for me is where is all the blood coming from? Anyway, I know it is tough to make a diagnosis on-line, but I appreciate your help.

Is she pseudophakic? I've seen blood and AC cell and flare with the IOL haptics chafing the iris. Other than that, I can only think of leaky neovascularization (but you should be able to see rubeosis and vessles in the angle), trauma, or malignancy. Is she anti-coagulated with coumadin or platelet inhibitors? This can also cause hyphemas.

Hyphemas resolve with time and treatment is usually not necessary. It's more important to reduce the IOP like you did. Your actions likely saved her vision because her IOP was encroaching into a pressure that would result in a central retinal artery occlusion.

[TomOD]

No IOL's (only mild NS). She was taking a daily aspirin until today (which I forgot to ask about initially...opps) but no coumadin. I suppose it's possible secondary to trauma but she has no signs and denies any significant hx?? I will let you know what happens.

[Kovox]

Heh

Thanks for the reply. I am going to the Opth tomorrow. After I used Tobradex the pain reduce significantly. Instead of the pain occuring every hour, it only occurs once a day now and is very minimal.


Optho: if yer ever in VA, I'll treat you to some "Pho."

TomOD: I will try those lenses you recommended Thanks

[Andrew_Doan]

Originally posted by Kovox
Heh

Thanks for the reply. I am going to the Opth tomorrow. After I used Tobradex the pain reduce significantly. Instead of the pain occuring every hour, it only occurs once a day now and is very minimal.


Optho: if yer ever in VA, I'll treat you to some "Pho."

TomOD: I will try those lenses you recommended Thanks

I LOVE PHO!!!