I love contact lenses. I have worn them for 14 years and my lenses have always been, shock horror, extended wear.  Yes, I keep my lenses in for a month at a time.  And I never had any problems.  I’ve never had an eye infection, despite blepharitis, and I must admit that my lens hygiene may sometimes have been remiss.  I’ve been pretty lucky.

Anyway, a few months ago, a twenty something girl came in for an eye test and contact lens fit.  She arrived wearing huge Jackie O sunglasses, which was strange since we were (obviously) indoors.  When I took her through to the prescreening area, she finally removed her sunglasses and I saw that her eyes were streaming.  Red, swollen lids, angry red conjunctiva – all the warning signs.  I told her that I thought contact lenses were a bad idea just now and that I wanted to check that her eyes were okay before we did anything else.

A quick look on the slit lamp with some fluorescein showed two big (2-3mm) corneal ulcers, one in each eye.  The girl had been wearing her lenses non-stop and didn’t own a pair of glasses.  I asked my supervisor to have a look to confirm.  I then called the hospital eye service and asked for her to be seen that day if possible.  The ophthalmologist asked if there was any hypopyon (there wasn’t).  He didn’t seem too concerned at first but when I told him that both eyes were affected and the ulcers were central, he agreed to see the girl that day.

Now, that was my first emergency referral.  I was quite proud of myself.  That is, until the girl called a few days later and told me the ophthalmologist had said her eyes were just “very dry” and she didn’t have ulcers.  Sigh.

So, today, I had another contact lens patient with a very sore, red eye.  She had come in for her aftercare (which was overdue) but wasn’t wearing her lenses.  She hadn’t had them in for a few days because her left eye was sore.  She didn’t have sunglasses so she just sat in our pre-screening area, in the dim light, looking pained and miserable.  I took her into the test room (I turned the lights down to the lowest setting so we were pretty much sitting in the dark for most of the exam).

I did a brief history and symptoms, trying to find out what had happened.  Her right eye was sore last week and now it was her left eye.  She was photophobic, her left eye was watering continually and she was in a lot of pain.  I thought it may be uveitis (this sounds awful but I need to see a patient with anterior uveitis as one of my visit three competencies).  There was no discharge, pupil reactions were normal.

I jumped on the slit lamp and had a quick look at her right eye (just to get her used to the light and to have a baseline for comparison).  When I looked at the left eye, I saw the problem straight away.  In amongst the grade 4 hyperaemia, little inclusion cysts on the conjunctiva and two large, peripheral corneal ulcers, there it was, the cause of all the problems: the forgotten lens.

Now, the patient insisted that she had taken her lenses out three days ago but here it was, welded to the front of her eye.  I asked her to look left and right and then look up to try and judge how much the lens was moving.  I didn’t want to try to remove it if it was stuck fast to her ulcerated, swollen cornea.  I thought I saw a tiny bit of movement (a fraction of a millimeter) but I decided to ask my supervisor to come in and check that it was okay to remove.  My supervisor came and and had a good look at the lens and said that it should be fine.

I popped a drop of OXY 0.4 in her left eye and we took the lens out.  Fluorescein showed the extent of the ulcers (two distinct ones, close to each other and 4mm away from the visual axis).  Now, since the ulcers in this case were peripheral, we decided to give her chloramphenicol ointment (to be used 5x a day) and then review tomorrow.  I told her to take some paracetamol for the pain and if it got worse tonight then to go to A&E.

What I don’t understand is, as someone with a moderately high prescription (>+5.00DS), how she didn’t notice the fact that she could still see out of her left eye, even with her lens supposedly out.

So that’s my little story for the day.