Patient History and Examination
Factors that increase the risk of complications with contact lens use include diabetes mellitus, especially if poorly controlled; immunosuppression; long-term use of topical ocular medications, such as corticosteroids; and occupational chemical or foreign body exposure. Other relative contraindications to contact lens use include an inability or history of failure to care for contact lenses, monocularity, abnormal eyelid function such as Bell palsy, severe dry eye, and corneal neovascularization.
The eyes and adnexa are examined for abnormalities of eyelid and lash position, tear film, and ocular surface. Eyelid movement should be observed. The cornea and conjunctiva should be evaluated carefully for signs of allergy, scarring, symblepharon, or other signs of conjunctival scarring diseases, such as ocular cicatricial pemphigoid and giant papillary conjunctivitis or abnormal vascularization resulting from previous lens wear. Through refraction and keratometry, the ophthalmologist can determine whether there is significant corneal, lenticular, or irregular astigmatism. The identification of irregular astigmatism may suggest other pathologies, such as keratoconus.
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.