From the Guidelines
For a 34-year-old female contact lens wearer with conjunctivitis, I recommend immediate discontinuation of contact lens use until the cornea returns to normal, as contact lens-related keratoconjunctivitis can lead to permanent damage if ignored 1. The patient's symptoms of an erythematous eye with no history of trauma suggest a possible case of contact lens-related keratoconjunctivitis, which can be caused by hypoxia of the limbal stem cells, leading to punctate epithelial keratitis, pannus, neovascularization, inflammation, edema, and ultimately epitheliopathy 1. Key points to educate the patient on include:
- Discontinuing contact lens wear until the cornea returns to normal to prevent further irritation and potential permanent damage
- Considering a brief course of topical corticosteroids for mild cases, and longer-term use of topical cyclosporine 0.05% 1
- Reviewing the contact lens fit, type, and care regimen at follow-up evaluation, and considering alternatives to contact lenses, such as eyeglasses or refractive surgery, once the keratoconjunctivitis has resolved 1
- Practicing proper lens care and hygiene, such as using nonpreserved lens care systems, daily disposable contact lenses, and high DK/T ratio material, to reduce the risk of infection and complications
- Avoiding sleeping in contacts unless specifically prescribed for extended wear, and never sharing contact lenses or lens care products to prevent reinfection.
From the FDA Drug Label
Avoid Contact Lens Wear Advise patients not to wear contact lenses if they have signs and symptoms of bacterial conjunctivitis [see WARNINGS AND PRECAUTIONS ( 5. 3) ]. 5.3 Avoidance of Contact Lens Wear Patients should be advised not to wear contact lenses if they have signs or symptoms of bacterial conjunctivitis.
The patient should be advised not to wear contact lenses while being treated for bacterial conjunctivitis.
- The patient should be educated on proper hygiene to prevent contamination of the eye drops and to avoid touching the dropper tip to any surface.
- The patient should be instructed to discontinue use of the eye drops and contact their physician if they experience any signs of an allergic reaction.
- The patient should be advised to return for follow-up to assess the effectiveness of the treatment and to rule out any potential complications. 2 2
From the Research
Treatment of Conjunctivitis in Contact Wearers
- The treatment of conjunctivitis in contact wearers typically involves the use of topical antibiotics, such as moxifloxacin or gatifloxacin, to reduce the duration of the infection and prevent complications 3, 4, 5.
- It is essential to educate the patient on proper contact lens hygiene and care to prevent the spread of infection and promote healing 4.
- The patient should be advised to:
- Avoid wearing contact lenses until the infection has cleared
- Clean and disinfect their contact lenses regularly
- Replace their contact lens case regularly
- Avoid sharing makeup or makeup brushes
- Wash their hands frequently, especially before touching their eyes
Education for Patient
- The patient should be informed about the importance of completing the full course of antibiotic treatment, even if symptoms improve before finishing the medication 3, 4.
- They should also be educated on the signs and symptoms of conjunctivitis, such as redness, itching, and discharge, and when to seek medical attention if they worsen or do not improve with treatment 4.
- Additionally, the patient should be advised to attend follow-up appointments to monitor the progress of the infection and adjust treatment as needed 4.
Antibiotic Resistance
- There is a concern about the development of antibiotic resistance in the treatment of conjunctivitis, particularly with the use of fluoroquinolones such as gatifloxacin and moxifloxacin 6, 7.
- However, studies have shown that the risk of resistance can be minimized by using these antibiotics judiciously and in accordance with established treatment guidelines 3, 5.