Change in corneal shape from contact lens use occurs with both soft and RGP lenses, but it is more commonly associated with hard lenses. Most warpage resolves after the patient discontinues wearing the lens. To evaluate corneal shape on an ongoing basis, the clinician can follow keratometry or corneal topography and manifest refraction as part of the contact lens follow-up examination. The common term spectacle blur misleadingly suggests that these changes are somehow due to a problem with the spectacle correction. If there is more than a little fluctuation of refractive error, the contact lens fit should be reevaluated.
Ptosis related to dehiscence of the levator aponeurosis has been associated with long-term use of RGP lenses.
Corneal abrasions can result from foreign bodies under a lens, poor insertion or removal technique, or a damaged contact lens. Most clinicians treat abrasions with topical antibiotics and try to avoid patching, particularly in the context of contact lens wear, to reduce the likelihood of infection.
3-o’clock and 9-o’clock staining
This specific superficial punctate keratitis staining pattern may be observed in RGP contact lens users, especially with interpalpebral fit, and is probably related to poor wetting (Fig 5-17). Paralimbal staining is characteristic of low-riding lenses and is associated with an abortive reflex blink pattern, insufficient lens movement, inadequate tear meniscus, and a thick peripheral lens profile. Refitting the lens or regular use of rewetting drops may help.
Excerpted from BCSC 2020-2021 series : Section 3 - Clinical Optics. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.