What is the treatment for conjunctivitis in a contact lens wearer?

Treatment of Conjunctivitis in Contact Lens Wearers

The primary treatment for conjunctivitis in contact lens wearers is immediate discontinuation of contact lens use until the cornea returns to normal, combined with appropriate medical therapy based on the specific type of conjunctivitis. 1

Types of Contact Lens-Related Conjunctivitis

1. Contact Lens-Related Keratoconjunctivitis

• Pathophysiology: Hypoxia of limbal stem cells causing punctate epithelial keratitis, pannus, neovascularization, inflammation, and edema 1
• Treatment:
  • Discontinue contact lens wear until cornea normalizes 1
  • Brief course (1-2 weeks) of topical corticosteroids 1
  • Longer-term use of topical cyclosporine 0.05% 1
  • Monitor for limbal stem cell failure (symptoms may be prolonged but usually clear with lens abstinence) 1

2. Giant Papillary Conjunctivitis (GPC)

• Treatment:
  • Discontinue contact lens use 1, 2
  • Topical anti-inflammatory agents 1, 2
  • For mild cases, consider:
    • Replacing lenses more frequently 1
    • Decreasing contact lens wearing time 1
    • Using preservative-free lens care systems 1
    • Administering mast cell stabilizing agents 1, 3
    • Refitting contact lenses 1
    • Switching to daily disposable lenses 1, 2
    • Changing the contact lens polymer 1
  • Treat associated conditions like aqueous tear deficiency and Meibomian gland dysfunction 1

3. Bacterial Conjunctivitis in Contact Lens Wearers

• Treatment:
  • Discontinue contact lens wear 1
  • Topical antibiotics (broad-spectrum) 4, 5
  • Consider cultures if severe or non-responsive 1
  • Systemic antibiotics for conjunctivitis secondary to sexually transmitted diseases 4

Follow-up Care

• Frequency based on severity of disease and treatment used 1
• At follow-up visits:
  • Obtain interval history 1
  • Measure visual acuity 1
  • Perform slit-lamp biomicroscopy 1
  • Review contact lens fit, type, and care regimen 1
  • Consider alternatives to contact lenses once keratoconjunctivitis resolves 1

Prevention of Recurrence

• Proper contact lens care instructions:
  • Rub and rinse lenses in disinfecting solution each time they are removed 1
  • Clean and rinse case with contact lens solution, dry with clean tissue, store upside down 1
  • Never "top off" solution; always use fresh disinfecting solution 1
  • Follow prescribed wearing and replacement schedule 1
  • Replace contact lens case every 3 months 1
  • Avoid water exposure when wearing contact lenses (swimming, showering) 1

Important Cautions

• If moderate or severe pain is present, consider amoebic keratitis 1
• If using corticosteroids, monitor intraocular pressure and pupillary dilation to evaluate for glaucoma and cataract 1, 2
• Never use topical antibiotics with corticosteroid components unless proven to be non-herpetic 5
• Long-term use of therapeutic contact lenses may increase risk of microbial keratitis 1

When to Refer to Ophthalmology

• Severe pain 6
• Decreased vision 6
• Immunocompromised state 6
• Non-responsive to treatment 5
• Suspected herpetic infection 5

By following this treatment algorithm, most cases of contact lens-related conjunctivitis can be effectively managed with good outcomes for vision and quality of life.