Altered conjunctival response after contact lens-related corneal inflammation

Purpose. Corneal inflammation in overnight contact lens (CL) wear is not fully understood. We designed a masked study to examine the impact of overnight CL wear on clinical variables in subjects who had previously experienced corneal inflammatory disease. Methods. Forty-four subjects were entered into the study: Nine subjects who had previously experienced CL-associated acute red eye (CLARE) and nine controls; 13 subjects who had previously experienced CL-induced peripheral ulceration (CLPU) and 13 controls, respectively. Controls were matched for age, gender, CL wear experience, and refractive error. Subjects wore bilateral disposable CLs (-3.00 DS). Corneal, conjunctival, and CL fitting variables were assessed prior to sleep, after a single night of CL wear, at 1, 2, and 4 hours after waking by clinicians who were masked to group membership. Retrospective analysis of prewear corneal and conjunctival variables for CLARE subjects and their respective controls was also performed. Results. Contact lens-associated acute red eye subjects consistently showed higher limbal redness (p < 0.05), bulbar redness (p < 0.05), and conjunctival staining (p < 0.005) compared with controls. Lens fitting and corneal variables were not significantly different at any time point for CLARE subjects. Contact lens-induced peripheral ulceration subjects were not different from matched controls for any variable at any time point. Limbal redness varied significantly over time among controls, with highest values measured at eye opening (p < 0.05). Retrospective analysis of prewear variables showed no significant differences between CLARE and control subjects. Conclusions. Wearers who previously experienced CLARE had a greater conjunctival response to CL wear compared with wearers who had no previous inflammatory disease. Clinical observations, however, were not helpful in predicting wearers who were predisposed to CLARE.