What is the treatment for a patient who develops conjunctivitis after sleeping in contact lenses (CL)?

Treatment of Conjunctivitis After Sleeping in Contact Lenses

Immediate Management: Remove Contact Lenses and Do Not Resume Until Complete Resolution

Immediately remove contact lenses and discontinue all wear until the cornea completely returns to normal—this is the most critical first step for all contact lens wearers presenting with conjunctivitis. 1

Critical Red Flags Requiring Urgent Evaluation

Before treating as simple conjunctivitis, you must rule out more serious conditions:

• Moderate to severe pain suggests bacterial keratitis or Acanthamoeba keratitis, particularly with history of swimming, showering, or hot tub use while wearing contacts 1
• Unilateral presentation with pain is more concerning for infectious keratitis than bilateral allergic or viral conjunctivitis 1
• Perform fluorescein staining to examine the cornea carefully—missing keratitis can lead to permanent vision loss 1

Treatment: All Contact Lens Wearers Require Topical Antibiotics

Unlike non-contact lens wearers where observation may be appropriate, all contact lens wearers with bacterial conjunctivitis require topical antibiotic therapy due to increased risk of bacterial keratitis. 1

Antibiotic Selection and Dosing

• Moxifloxacin 0.5% ophthalmic solution 3 times daily for 4 days is an effective first-line choice, with clinical cure rates of 66-69% and microbiological eradication rates of 84-94% 2
• Alternative fluoroquinolones are also appropriate for contact lens-related infections 1

Additional Considerations for Mild Cases

• For mild contact lens-related keratoconjunctivitis (not simple conjunctivitis), consider a brief 1-2 week course of topical corticosteroids 1
• Longer-term topical cyclosporine 0.05% may be considered for managing inflammation in mild cases 1

Critical Warnings During Treatment

• Patients must not wear contact lenses if they have any signs or symptoms of bacterial conjunctivitis 2
• Discontinue moxifloxacin immediately if allergic reaction occurs—serious hypersensitivity reactions have been reported with quinolones 2
• Prolonged antibiotic use may result in overgrowth of resistant organisms; examine with slit-lamp biomicroscopy when clinically indicated 2

Follow-Up: Comprehensive Contact Lens Practice Review

At follow-up evaluation, address these specific risk factors:

• Review contact lens type, fit, and wearing schedule—consider switching to daily disposable lenses 1
• Evaluate cleaning and disinfection regimen—consider non-preserved lens care systems 1
• Assess water exposure habits—strongly discourage overnight wear as it increases corneal infection risk fivefold compared to daily wear 1
• Educate on water avoidance: never swim, shower, use hot tubs, or wash hair while wearing contact lenses due to Acanthamoeba risk 1

Specific Hygiene Instructions

• Never rinse contact lenses or cases with tap water, bottled water, or homemade saline 1
• Replace solution completely each time—never top off 3
• Rub and rinse lenses with fresh solution even if using "no-rub" solutions 1
• Replace lens cases every 3 months minimum 3, 1
• Wash hands with soap and water before handling lenses every time 3

Common Pitfalls to Avoid

• Failing to discontinue contact lens wear during treatment leads to prolonged infection and complications 1
• Resuming contact lens wear too early before complete resolution leads to recurrence and chronic issues 1
• Treating all contact lens-related conjunctivitis as simple bacterial infection without considering keratitis through fluorescein examination 1
• Missing Acanthamoeba keratitis in patients with pain and water exposure history—this requires specialized treatment and can cause permanent vision loss 1