What is the treatment for a patient with conjunctivitis who wears contact lenses?

Treatment of Conjunctivitis in Contact Lens Wearers

Immediately discontinue contact lens wear and do not resume until the cornea completely returns to normal. 1, 2

Critical Initial Assessment

Rule out sight-threatening conditions first:

• If moderate or severe pain is present, suspect Acanthamoeba keratitis, particularly with history of water exposure (swimming, showering, hot tubs) while wearing contacts 1, 2
• Examine for punctate epithelial keratitis, pannus, neovascularization, inflammation, and edema—these indicate contact lens-related keratoconjunctivitis from limbal stem cell hypoxia 1, 2
• Contact lens wearers with conjunctivitis should always be treated for bacterial conjunctivitis and referred to ophthalmology to evaluate for corneal ulcers 3

Pharmacologic Treatment

For mild contact lens-related keratoconjunctivitis:

• Prescribe a brief 1-2 week course of topical corticosteroids 1, 2
• Add topical cyclosporine 0.05% for longer-term use to manage ongoing inflammation 1, 2

Important caveat: If corticosteroids are used, perform baseline and periodic IOP measurements and pupillary dilation to monitor for glaucoma and cataracts 1

Follow-Up Evaluation and Contact Lens Modification

At the follow-up visit, systematically review and modify the contact lens regimen:

• Switch to daily disposable contact lenses (preferred) 1, 2
• Use non-preserved lens care systems 1, 2
• Select high DK/T ratio materials for better oxygen transmission 1, 2
• Reduce total contact lens wearing time 1, 2
• Refit lenses if current fit is suboptimal 1

Long-Term Management Considerations

Consider permanent alternatives to contact lenses (eyeglasses or refractive surgery) once the keratoconjunctivitis has fully resolved 1, 2

If the patient insists on resuming contact lens wear, provide strict hygiene education:

• Never rinse lenses or cases with any type of water (tap, bottled, or homemade saline) 1, 2
• Replace contact lens cases every 3 months minimum 1, 2
• Never "top off" solution—always use fresh disinfecting solution 1, 2
• Hydrogen peroxide systems are superior to preserved solutions for reducing pathogen binding, though they require more complex care 1, 2

Critical Warnings to Prevent Recurrence

Overnight wear increases corneal infection risk fivefold compared to daily wear—even occasional overnight use is discouraged 1, 2

Avoid all water contact while wearing lenses:

• No swimming, hot tubs, showering, bathing, or hair washing with lenses in place 1, 2

Common Pitfalls

Failing to discontinue contact lens wear during active conjunctivitis leads to prolonged infection, permanent epitheliopathy, and potential vision loss 1, 2, 4

Resuming contact lens wear before complete corneal healing causes recurrence and chronic inflammation 2

If symptoms are prolonged and related to limbal stem cell failure, they will ultimately clear with sustained contact lens abstinence, though this may take weeks to months 1