97th DOG Annual Meeting 1999
CONTACT LENS INDUCED ENDOTHELIAL-EPITHELIAL DAMAGE OF THE CORNEA
I. Eggers1, H. Krastel1, L. Frisch2, H. E. Völcker1
Common corneal effects of contact lens overwear include epithelial lesions and ingrowth of limbal vessels. However, casually the endothelium may be the site of primary damage.
Case report: The patient presented with findings mimicking Fuchs´ endo-epithelial dystrophy. Now aged 47, she had used soft contact lenses in her left eye for 20 years. Cystic endothelial edema ("blebs"), stromal swelling (with descemet folds) and bullous epitheliopathy coined the appearance of her cornea. There was no correction in the amblyopic right eye and there were no findings in this eye indicative of any corneal pathology. After the patient refrained from wearing contact lenses a decrease of corneal thickness and less decompensation signs were noted, as detected by Orbscan and slitlamp examination. Unfortunately, the visual acuity remained unsatisfactory due to the uneven corneal surface. The patient decided on wearing contact lenses again.
Discussion: The varying extent of corneal hypoxia induces endothelial polymegatism and polymorphism by increase and decrease of intracellular edema. The leads to destruction, migration and rosette formation of the endothelial cells. Only in early stages, short term improvement of findings is possible. Therefore, early diagnosis and early treatment are essential for successful management Follow up of contact lens users should not only include checks of good fit, of limbal vessels, of the conjunctiva, and of fluoresceine staining of the epithelium, but also give special attention to the corneal endothelium. Presence of guttae or other signs of decompensation must lead to immediate termination of wearing contact lenses. Otherwise it may occur that the patient can only experience acceptable vision by using the harmful lens.
University Eye-Hospital Heidelberg1, INF 400, 69120 Heidelberg,
University Eye-Hospital Mainz2, Langenbeckstr. 1, 55131 Mainz