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The effect of prolonged and nocturnal use of contact lenses on the cornea: about a case of corneal decompensation and decreased endothelial count
El efecto del uso prolongado y nocturno de las lentes de contacto en la córnea. A propósito de un caso de descompensación corneal y descenso del recuento endotelial
G. Castilla Martinez
, C.P. Tarazona Jaimes, C.E. Monera Lucas
Corresponding author
Departamento de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, Spain
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"apellidos" => "Fernández-Vigo" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0365669123000011" "doi" => "10.1016/j.oftal.2022.12.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365669123000011?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S217357942300018X?idApp=UINPBA00004N" "url" => "/21735794/0000009800000004/v2_202304071550/S217357942300018X/v2_202304071550/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Short communication</span>" "titulo" => "The effect of prolonged and nocturnal use of contact lenses on the cornea: about a case of corneal decompensation and decreased endothelial count" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "238" "paginaFinal" => "242" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "G. Castilla Martinez, C.P. Tarazona Jaimes, C.E. Monera Lucas" "autores" => array:3 [ 0 => array:4 [ "nombre" => "G." "apellidos" => "Castilla Martinez" "email" => array:1 [ 0 => "germiswim@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "C.P." "apellidos" => "Tarazona Jaimes" ] 2 => array:2 [ "nombre" => "C.E." "apellidos" => "Monera Lucas" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Departamento de Oftalmología, Hospital General Universitario de Elche, Elche, Alicante, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El efecto del uso prolongado y nocturno de las lentes de contacto en la córnea. A propósito de un caso de descompensación corneal y descenso del recuento endotelial" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3374 "Ancho" => 3341 "Tamanyo" => 1150223 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Endothelial count, corneal pachymetry and central corneal thickness (CCT or central) post-treatment. RE left image and LE right image. The CCT has decreased compared to the first visit: RE 567 μm and LE 560 μm. The endothelial count is 1,278 cells/mm<span class="elsevierStyleSup">2</span> in the RE and 1,073 cells/mm<span class="elsevierStyleSup">2</span> in the LE.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Clinical case</span><p id="par0005" class="elsevierStylePara elsevierViewall">The case of a 67-year-old female who consulted for bilateral blurred vision of several days' duration, with no other associated ophthalmological symptoms, is presented. She did not present ocular pain, photophobia or foreign body experience.</p><p id="par0010" class="elsevierStylePara elsevierViewall">During anamnesis, the patient reported the use of contact lenses for 40 years, explaining that she wears them all day long, several days in a row and even while sleeping, adding that "they are special contact lenses". No additional personal history of interest was reported.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Examination showed a best corrected visual acuity (BCVA) of 0.4 in the right eye (RE) and 0.3 in the left eye (LE). Biomicroscopy of both eyes showed: unaltered eyelids, non-hyperemic conjunctiva, cornea with small central epithelial defects staining with fluorescein and mild stromal oedema, negative Tyndall, normal iris and clear lens (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The fundus examination showed no alterations in the posterior pole.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Corneal topography showed a central corneal thickness (CCT) of 619 μ m in the RE and 628 μ m in the LE. In addition, a manual endothelial count (ER) was performed with a result of 1,251 cells/mm<span class="elsevierStyleSup">2</span> in the RE, with signs of polymetastasis, and the count was impossible in the LE, although it was seen to be reduced (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In view of these findings, total corneal involvement (epithelium, stroma and endothelium) due to contact lens abuse was suspected. The patient was asked to stop using contact lenses and was prescribed Tobradex eye drops® in descending doses for 3 weeks and Antiedema eye drops® 4 times/day until the next check-up, which would be in one month's time. In addition, the patient was asked to bring the packaging of the "special contact lenses" to the next check-up, which can be used for several days in a row and even at night.</p><p id="par0030" class="elsevierStylePara elsevierViewall">One month later, the patient reported that she had completely recovered from the symptoms for which she had consulted. She presented with a BCVA of 1.0 in both eyes with her spectacles and on slit lamp examination and, after repeating the corneal topography and manual ER, the results have normalised except for a relatively low endothelial cell count (1,278 cells/mm<span class="elsevierStyleSup">2</span> in the RE and 1,063 cells/mm<span class="elsevierStyleSup">2</span> in the LE) (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">The patient shows her "special contact lenses", which are actually silicone hydrogel lenses for daily use with a +3.25 dioptre sphere for both eyes. She confirmed that, after consulting her optician, she mistakenly understood that the contact lenses could be used continuously. At this point it was decided to discontinue the treatment and the patient was discharged.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Comment</span><p id="par0040" class="elsevierStylePara elsevierViewall">Reviewing the literature on the disease in this case we discovered that the side effects of contact lenses were already extensively studied in the second half of the last century, as their emergence forced a better understanding of corneal metabolism and the impact that said lenses could create on it.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The cornea is an avascular structure that needs to be transparent to perform its refractive and visual function. It needs tears for nourishment, oxygenation and elimination of metabolic waste. Contact lenses create a physical barrier that alters the cornea's natural ability to allow oxygen to pass through by direct diffusion from the atmosphere, and can lead to corneal hypoxia.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">When hypoxia is persistent, the cells die, causing erosions that give rise to the classic surface symptoms (blurred vision, pain, tearing, photophobia). On the other hand, chronic low-grade hypoxia, as in the case of the present patient, causes imperceptible changes in the structure and function of the cornea that become progressively apparent. Examination in these cases may show central epithelial microcysts, peripheral corneal neovascularisation, stromal thickening and edema ("Sattler's veil"), Descemet's membrane folding and endothelial damage.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The above effects are due to the metabolic acidosis of the cornea, especially the endothelium. Therefore, the prolonged use and, especially, the use of contact lenses at night, aggravate this situation. According to the literature, while the eyelids are closed the cornea receives barely 1/3 of the oxygen (55 mmHg or 7% of O<span class="elsevierStyleInf">2</span> at sea level) that it normally has when open (155 mmHg or 20.95% of O<span class="elsevierStyleInf">2</span>).<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> When a person is sleeping, transparency alterations occur due to edema. It is estimated that physiological edema at night is 2–4% in eyes without contact lenses, which can be dangerously aggravated if a contact lens is placed in front of the eye, preventing the passage of gases from the vessels of the tarsal conjunctiva to the corneal epithelium, reaching edema values of over 10%.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7–9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">As these effects were described in the literature, contact lenses evolved and improved their technology in terms of gas transmissibility, rigidity, size, degree of hydration, etc. until reaching the current lenses which continute to produce side effects but to a lesser extent.</p><p id="par0065" class="elsevierStylePara elsevierViewall">Therefore, the present case is an example of the effects at all levels that can be produced in the cornea after continued misuse of contact lenses, ranging from the epithelial damage observed in the images of the anterior pole to the stromal edema confirmed by pachymetry and ending with the decrease in endothelial cells shown by the count. Thus, knowledge of these complications will enable improved diagnosis and treatment.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Funding</span><p id="par0070" class="elsevierStylePara elsevierViewall">This research has not received specific support from public sector agencies, the commercial sector or non-profit organisations.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Conflicts of interest</span><p id="par0075" class="elsevierStylePara elsevierViewall">No conflicts of interest were declared by the authors.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1876909" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1628168" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1876910" "titulo" => "Resumen" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0010" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1628167" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical case" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Comment" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Funding" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflicts of interest" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2022-11-12" "fechaAceptado" => "2023-01-26" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1628168" "palabras" => array:5 [ 0 => "Contact lenses" 1 => "Corneal edema" 2 => "Corneal descompensation" 3 => "Corneal hypoxia" 4 => "Low endothelial count" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1628167" "palabras" => array:5 [ 0 => "Lentes de contacto" 1 => "Edema corneal" 2 => "Descompensación corneal" 3 => "Hipoxia corneal" 4 => "Recuento endotelial bajo" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Corneal edema and decreased endothelial cell count are complications related to chronic low-grade hypoxia experienced by contact lens wearers, primarily due to prolonged and overnight wear. This case shows the example of a patient who has blurred vision problems in both eyes and who underwent a complete ophthalmologic examination that included photographs, corneal topography and endothelial cell count. Subsequently, the corneal metabolism, the etiopathogenesis and the complications derived from the use of contact lenses are reviewed.</p></span>" ] "es" => array:2 [ "titulo" => "Resumen" "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">El edema corneal y la disminución del recuento de células endoteliales son complicaciones relacionadas con la hipoxia crónica de bajo grado que experimentan los usuarios de lentes de contacto, principalmente debido al uso prolongado y nocturno. Este caso muestra el ejemplo de un paciente que presenta problemas de visión borrosa en ambos ojos y a quien se le realizó un examen oftalmológico completo que incluyó fotografías, topografía corneal y conteo de células endoteliales. Posteriormente se revisa el metabolismo corneal, la etiopatogenia y las complicaciones derivadas del uso de lentes de contacto.</p></span>" ] ] "multimedia" => array:3 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 335 "Ancho" => 1005 "Tamanyo" => 37101 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">RE left image and LE right image. More marked epitheliopathy is seen in the RE, which stains with fluorescein.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 3466 "Ancho" => 3333 "Tamanyo" => 686372 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Endothelial count, corneal pachymetry and central corneal thickness (CCT or central) pre-treatment. RE left image and LE right image. The CCT of the RE shows a result of 619 μm and the CCT of the LE shows a result of 628 μm. The endothelial count is 1,251 cells/mm<span class="elsevierStyleSup">2</span> in the RE, while the count in the LE is not possible, although it appears decreased.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 3374 "Ancho" => 3341 "Tamanyo" => 1150223 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Endothelial count, corneal pachymetry and central corneal thickness (CCT or central) post-treatment. RE left image and LE right image. The CCT has decreased compared to the first visit: RE 567 μm and LE 560 μm. 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