CORNEAL ULCER

This is a 29 year old patient who wears her Acuvue Oasys Contact Lenses from the time she gets up until she goes to bed, every day. She complained of pain, redness, and light sensitivity.

Examination shows a single corneal ulcer. This is a bacterial ulcer, similar to what occurs with stomach ulcers. It must be treated very aggressively with a high initial dosage of very potent topical antibiotics and the patient must be followed nearly every day until resolution.

This patient is very fortunate. The ulcer is located peripherally enough that any scar will not effect her vision. She also came in early enough to limit it's progression before it became worse. These ulcers can cause permanent decrease in vision, due to scarring along the visual axis. Aggressive, poorly managed ulcers can cause complete loss of the eye.

People with problems like this are always those who over-wear their contact lenses and they don't dispose of their lenses when they're supposed to. For some reason the patients I see coming in to my office are usually wearing Acuvue Oasys lenses.

The people who do the best in contact lenses are those who rest their eyes from the contacts a few hours a day and a day or two a week.

FOREIGN BODY TRACKS POINT TO THE PROBLEM

A patient of mine showed up one Monday morning complaining of pain in his eye. He said the wind was blowing two days earlier and he thinks that something flew into his eye. No matter how much he flushes the eye out, he can't get rid of it.

When I first looked at him, I couldn't see anything wrong. The cornea looked normal and the eye wasn't red. I flipped the eye lid to look under it and didn't see anything there. So then I put dye in the eye and under red-free light I saw the following on the cornea:

If you magnify the above picture and dim the lights, you'll see several vertical lines in the cornea. These lines represent scratches on the surface of the cornea caused by something trapped under the upper lid. So I knew there had to be something there. Usually a foreign body is metallic and easily identifiable.

On closer look I was able to identify a clear piece of plastic under the lid. I pulled it out and the patient had immediate relief.

CONTACT LENS LOOKING LIKE A PETRI DISH

This is a patient who wears his Purevision Toric contact lenses longer than a month and doesn't remove them. When your contact lenses look like a Petri Dish, you know you're abusing your contact lenses...and your eyes!