A Guide to Clinical Contact Lens Management

Signs, Symptoms, Diagnosis and Management

Academy for Eyecare Excellence™
IN COOPERATION WITH
Centre for Contact Lens Research
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Lens solution sensitivity slit lamp

Lens Solution Toxicity

Symptoms

  • Stinging or burning on lens insertion
  • Visual symptoms if severe

Signs

  • Localized disruption of the corneal epithelial surface (superficial punctate keratitis) – often marked
  • Absence of corneal infiltrates

Etiology

  • Effects are generally related to concentration and dosage of chemical preservative(s)
  • Toxic effects of solution components potentially include hydrogen peroxide (inadequate neutralization), thimerosal, benzalkonium chloride, chlorhexidine
  • Rare with modern, higher molecular weight preservatives such as polyhexamethylenebiguanide (PHMB) and Polyquaternium

Prevalence

  • Uncommon with current multipurpose solutions. Will occur more frequently with inadequate hydrogen peroxide neutralization

Differential Diagnosis

Management

  • Counsel on need to neutralize hydrogen peroxide
  • Rinse lenses with saline prior to insertion
  • Consider minimal maintenance options including DD lenses
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