Contact Lens Acute Red Eye Inflammation
Posted by Dr. J. R. Lacey, Therapeutic Optometrist
Contact Lens Acute Red Eye (CLARE) is an Inflammation caused by Deposits or Bacterial By-Products on Contact Lenses
Contact Lens Acute Red Eye (CLARE) is an inflammation of the outer surface of the eye that occurs only in patients wearing contact lenses. CLARE is actually more of a description of a contact lens related problem than an actual clinical disease; eye doctors must rule out other diseases that can cause similar symptoms such as microbial keratitis, infectious corneal ulcers or iritis.
Causes of Contact Lens Acute Red Eye (CLARE)
Protein deposits or by-products of bacteria that adhere to the surface of a contact lens can cause the cornea and conjunctiva to become inflamed because of an immune reaction. The result is a condition called CLARE. Protein from the tears of the eyes accumulates on the surface of a contact lens while being worn. Some protein and other debris remains on the lens surface even after a lens is cleaned. Bacterial debris known as endotoxins that are released from gram-negative bacteria on the lenses or in the solutions or contact lens cases are responsible for this immune reaction. Very specific strains of gram-negative bacteria species have been isolated and identified from CLARE patients and include Pseudomonas, Serratia and Haemophilus influenzae. CLARE is much more common in patients that sleep in contacts for extended periods.
Not sleeping in the lenses and frequent replacement of lenses minimizes or eliminates the problem because the lenses are disposed of prior to significant accumulation of protein and bacterial debris on the lens surface.
CLARE is also more common in patients with dry eyes, blepharitis and ocular allergies.
Signs and Symptoms of CLARE - Contact Lens
Acute Red Eye
The signs and symptoms of CLARE include pain or discomfort, redness of the eyes (conjunctival hyperemia), itching, photophobia (light sensitivity) and watery eyes. The redness tends to be worse
near the limbus (around the color part of the eye). The condition is usually only present in one eye and is not contagious.
Master Eye Associates experts utilize a high powered microscope to perform slit lamp biomicroscopy and will often see infiltrates (white blood cells) that have migrated into the inner layers of the cornea (sub-epithelial infiltrates). There may also be evidence of small punctate areas of erosion of the corneal epithelium (outer most layer of the cornea).
Treatment of Contact Lens Acute Red Eye
Treatment protocol for CLARE includes immediate and temporary discontinuation of contact lenses and anti-inflammatory medicine (eye drops). An antibiotic drop may also be prescribed If there is also a disruption of the corneal epithelium (outermost layer of the cornea).
New contact lenses should be prescribed after the inflammation subsides. The new contacts should provide more oxygen transmission. Additionally, more frequent lens replacement intervals and a reduction or elimination of overnight contact lens wear should be implemented.
