What is the recommended treatment for a patient with conjunctivitis (inflammation of the conjunctiva) who wears contact lenses?

Treatment of Conjunctivitis in a Contact Lens Wearer

For a patient with conjunctivitis who wears contact lenses, the first step is to discontinue contact lens wear until the cornea returns to normal. 1

Initial Management

• Immediately remove contact lenses and discontinue wear until the cornea completely returns to normal 1
• Consider the possibility of contact lens-related keratoconjunctivitis, which presents with punctate epithelial keratitis, pannus, neovascularization, inflammation, and edema due to limbal stem cell hypoxia 1
• Rule out Acanthamoeba keratitis, which should be suspected if moderate or severe pain is present, especially with history of swimming or showering while wearing contacts 1

Treatment Options

• For mild cases of contact lens-related conjunctivitis:

  • Prescribe a brief (1-2 weeks) course of topical corticosteroids 1
  • Consider longer-term use of topical cyclosporine 0.05% to manage inflammation 1
  • Use preservative-free artificial tears for symptomatic relief 2

• For bacterial conjunctivitis in contact lens wearers:

  • Prescribe a topical antibiotic (fluoroquinolones are effective but should be used judiciously) 3, 4
  • Consider gentamicin, tobramycin, or azithromycin as preferred first-line options to reduce resistance development 5
  • Moxifloxacin can be considered for more severe infections due to its high potency and favorable pharmacokinetics 6

• For allergic conjunctivitis component:

  • Topical antihistamines with mast cell-stabilizing activity are recommended 4
  • Avoid preservative-containing formulations as they can cause additional allergic reactions 2

Follow-up Care

• At follow-up evaluation, review the contact lens fit, type, and care regimen 1
• Consider recommending:
  • Non-preserved lens care systems 1
  • Daily disposable contact lenses 1
  • High DK/T ratio material lenses 1
  • Reduced contact lens wearing time 1

Important Precautions

• Patients should be instructed not to rinse contact lenses or cases with tap water, bottled water, or homemade saline 1
• Contact lens cases should be cleaned and replaced at least every 3 months 1
• Patients should use only fresh contact lens disinfecting solution and never mix old and new solutions 1
• Hydrogen peroxide systems may be superior to preserved disinfecting solutions in reducing pathogen binding, but require more complex care regimens 1

Long-term Recommendations

• Consider alternatives to contact lenses (eyeglasses or refractive surgery) once the keratoconjunctivitis has resolved 1
• Schedule regular eye examinations to monitor lens fit, ocular health, and reinforce proper lens care and hygiene 1
• Advise patients that overnight wear of contact lenses increases the risk of corneal infections fivefold compared to daily wear 1
• Warn patients about the risks of wearing contact lenses while swimming, sitting in hot tubs, showering, or bathing 1

Common Pitfalls to Avoid

• Failing to discontinue contact lens wear during treatment can lead to prolonged infection and complications 1
• Using preserved eye drops can exacerbate inflammation and allergic reactions 2
• Patching the eye or using therapeutic contact lenses for corneal abrasions in contact lens wearers increases risk of secondary bacterial keratitis 1
• Resuming contact lens wear too early before complete resolution can lead to recurrence and chronic issues 1