Keratitis Related to a Multipurpose Contact Lens Solution

1
Keratitis Related to a Multipurpose Contact Lens
Solution

• Jules Winokur, MD
• Michelle Lee, OD
• Mohamed Osman, BS
• Sid Mandelbaum, MD

Authors have no financial interest
2
Purpose

• To describe a non-infectious corneal condition
  associated with use of contact lenses disinfected
  with a multipurpose contact lens solution (MPS)

Methods

• Observational case series
• Private corneal practice
• Retrospective chart review

3
Clinical Findings

• Symptoms included
• Ocular redness
• Irritation
• Decreased lens tolerance
• Decreased visual acuity

• Signs included some combination of
• Punctate corneal fluorescein staining (SPK)
• Pinpoint white epithelial opacities, only some of
  which stain with fluorescein
• Conjunctival injection
• Epithelial microcysts
• Small sub-epithelial opacities
• Limbal thickening
• Whorl-like epitheliopathy

4
Microcysts, fluorescein stain
Sub-epithelial opacity
Pinpoint white epithelial opacities, only some of
which stain with fluorescein
5
Findings

• 26 patients over three year period
• All patients used Opti-free solutions
• Most patients had more than one finding

6
Treatment

• Many of the patients had already used topical
  antibiotics and topical steroids without apparent
  improvement
• Cessation of contact lenses and elimination of
  Opti-free solution was effective treatment
• Resolution of signs and symptoms ranged from 3
  days to gt 6 months
• Patients with more severe findings at
  presentation took longer to resolve
• No patient had recognizable permanent sequelae

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Outcomes

• All patients with long-term follow-up returned to
  CL use
• Many patients successfully resumed CL use with
  the same lens parameters, but with hydrogen
  peroxide disinfection
• Some patients switched to daily disposable
  contact lenses
• Several patients who returned to Opti-free
  solution disinfection had recurrence of clinical
  picture

8
Background

• In 2002, 32,000,000 people using lenses in US1,
  87 using soft lenses
• Opti-free is the most commonly used solution for
  soft lens disinfection

Figure 1 Type of soft CL use in US2
Figure 2 Market share of disinfecting solutions3
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Antimicrobials in MPS

• Polyhexamethylene biguanide (PHMB)
• Renu Multiplus (0.00005) BL
• AQuify (0.0001) Ciba
• Myristamidopropyl dimethylamine (Aldox)
• Opti-free (0.0005) Alcon
• Polyquaternium-1 (Polyquad)
• Opti-free (0.001) Alcon

Opti-free solutions contain both Aldox and
Polyquad
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Possible Relationships

• Aldox and Polyquad are proprietary disinfectants
  used only in Opti-free
• In vitro studies show cytotoxicity and decreased
  corneal epithelial cell viability after exposure
  to Opti-free4,5,6
• Study in rats did not show toxicity from
  Polyquad7,8
• Combination of factors likely responsible for
  clinical condition

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Discussion

• Opti-free multipurpose contact lens solution may
  be associated with a particular pattern of
  corneal findings
• Corneal abnormalities slowly resolve with
  discontinuation of contact lens use
• These patients were able to resume use of contact
  lenses with a daily disposable lens or
  peroxide-based disinfecting system

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Notes

1. Barr, Joseph. "Contact Lenses 2002 Annual
   Report." Contact Lens Spectrum  Jan. 2003 24-31.
   
2. Nichols, JJ. http//www.clspectrum.com/article.asp
   x?article103778 Diagram reproduced with
   permission from author.
3. Ibid 2.
4. Mowrey-McKee M, Sills A, Wright A, CIBA Vision
   Corporation. Comparative cytotoxicity potential
   of soft contact lens care regimens. CLAO J. 2002
   Jul28(3)160-4.
5. Wright A, Mowrey-McKee M. Comparative
   cytotoxicity potential of soft contact lens care
   products. Cutan Ocul Toxicol. 200524(1)53-64.
6. Cavet ME, Harrington KL, VanDerMeid KR, Ward KW,
   Zhang JZ. Comparison of the effect of
   multipurpose contact lens solutions on the
   viability of cultured corneal epithelial cells.
   Cont Lens Anterior Eye. 2009 Aug32(4)171-5.
   Epub 2009 Jun 21.
7. Tripathi BJ, Tripathi RC, Kolli SP. Cytotoxicity
   of ophthalmic preservatives on human corneal
   epithelium. Lens Eye Toxic Res.
   19929(3-4)361-75.
8. Labbé A, Pauly A, Liang H, Brignole-Baudouin F,
   Martin C, Warnet JM, Baudouin C. Comparison of
   toxicological profiles of benzalkonium chloride
   and polyquaternium-1 an experimental study. J
   Ocul Pharmacol Ther. 2006 Aug22(4)267-78.