School of Optometry & Vision Science, UNSW Sydney, NSW, Australia.
Faculty of Applied Medical Sciences, Department of Allied Medical Sciences, Jordan University of Science and Technology, Jordan.
Cont Lens Anterior Eye. 2021 Apr;44(2):330-367. doi: 10.1016/j.clae.2021.02.010. Epub 2021 Mar 25.
Contact lens-related complications are common, affecting around one third of wearers, although most are mild and easily managed. Contact lenses have well-defined anatomical and physiological effects on the ocular surface and can result in other consequences due to the presence of a biologically active material. A contact lens interacts with the tear film, ocular surface, skin, endogenous and environmental microorganisms, components of care solutions and other antigens which may result in disease specific to contact lens wear, such as metabolic or hypersensitivity disorders. Contact lens wear may also modify the epidemiology or pathophysiology of recognised conditions, such as papillary conjunctivitis or microbial keratitis. Wearers may also present with intercurrent disease, meaning concomitant or pre-existing conditions unrelated to contact lens wear, such as allergic eye disease or blepharitis, which may complicate the diagnosis and management of contact lens-related disease. Complications can be grouped into corneal infection (microbial keratitis), corneal inflammation (sterile keratitis), metabolic conditions (epithelial: microcysts, vacuoles, bullae, tight lens syndrome, epithelial oedema; stromal: superficial and deep neovascularisation, stromal oedema [striae/folds], endothelial: blebs, polymegethism/ pleomorphism), mechanical (corneal abrasion, corneal erosion, lens binding, warpage/refractive error changes; superior epithelial arcuate lesion, mucin balls, conjunctival epithelial flaps, ptosis, discomfort), toxic and allergic disorders (papillary conjunctivitis, solution-induced corneal staining, incomplete neutralisation of peroxide, Limbal Stem Cell Deficiency), tear resurfacing disorders/dry eye (contact lens-induced dry eye, Meibomian gland dysfunction, lid wiper epitheliopathy, lid parallel conjunctival folds, inferior closure stain, 3 and 9 o'clock stain, dellen, dimple veil) or contact lens discomfort. This report summarises the best available evidence for the classification, epidemiology, pathophysiology, management and prevention of contact lens-related complications in addition to presenting strategies for optimising contact lens wear.
接触镜相关并发症很常见，影响约三分之一的佩戴者，尽管大多数是轻度的，且易于处理。接触镜对眼表面具有明确的解剖学和生理学作用，并由于存在生物活性物质而导致其他后果。接触镜与泪膜、眼表面、皮肤、内源性和环境微生物、护理液成分以及其他抗原相互作用，可能导致与接触镜佩戴相关的特定疾病，如代谢或过敏紊乱。接触镜佩戴还可能改变已识别疾病的流行病学或病理生理学，如乳头性结膜炎或微生物性角膜炎。佩戴者也可能出现并发疾病，即与接触镜佩戴无关的同时存在或先前存在的疾病，如过敏性眼病或睑缘炎，这可能使接触镜相关疾病的诊断和管理复杂化。并发症可分为角膜感染（微生物性角膜炎）、角膜炎症（无菌性角膜炎）、代谢性疾病（上皮：微囊、空泡、大疱、紧镜综合征、上皮水肿；基质：浅层和深层新生血管化、基质水肿[条纹/褶皱]；内皮：隆起、多核巨细胞/多形性）、机械性（角膜擦伤、角膜侵蚀、镜片粘连、镜片变形/屈光不正改变；上表皮层弓形病变、黏液球、结膜上皮瓣、上睑下垂/不适）、毒性和过敏紊乱（乳头性结膜炎、溶液诱导的角膜染色、过氧化物不完全中和、角膜缘干细胞缺乏症）、泪膜表面疾病/干眼（接触镜引起的干眼、睑板腺功能障碍、眼睑擦拭上皮病、眼睑平行结膜皱褶、下闭合染色、3 点和 9 点染色、环、穹窿面纱）或接触镜不适。本报告总结了接触镜相关并发症的分类、流行病学、病理生理学、管理和预防的最佳现有证据，并提出了优化接触镜佩戴的策略。
