FOR OPTOMETRY STUDENTS, ACUTE RED EYE AND SYMPTOMS AFTER WEARING A LONG TERM CONTACT LENS WITHOUT PROPER PROCEDURE Contact lens-induced acute red eye (CLARE) occurs in the presence of corneal hypoxia combined with noninvasive gram-negative bacteria that elicit an inflammatory reaction secondary to bacterial endotoxin. No actual corneal infection exists in this case

1. TOPIC- CONTACT LENS INDUCEDACUTE
REDEYE
NAME- SUSHRITA MAHADANI

2. Contact lens-induced acute red eye (CLARE) occurs in the presence of
corneal hypoxia combined with noninvasive gram-negative bacteria that
elicit an inflammatory reaction secondary to bacterial endotoxin. No
actual corneal infection exists in this case.

3. Symptoms:-
 Pain
 Discomfort
 Redness (Conjunctival hyperaemia)
 Itching
 Photophobia
 Watery eyes
Etiology:-
 Bacterial contamination
 Hypoxia
 Tight lens
 deposits

4. CLARE presentation can be unilateral or bilateral and consists of mild to moderate conjunctival
hyperemia with associated corneal infiltrates located in the periphery to midperiphery. The
infiltrates have no associated epithelial defect, distinguishing CLARE from both contact lens-
induced peripheral ulcer (CLPU) and microbial keratitis (MK).
Risk factors for CLARE include extended wear with poor replacement schedule, deficient lens
and storage environment hygiene. Of note, H. influenza, a gram-negative bacteria, can colonize
in the nasopharynx and lead to CLARE in patients who have recently been sick with the flu.
Management:-
• Cease contact lens usage
• Improve hygiene
• Fit frequent replacement lens
• Fit low water content lens
• Avoid tight lens fit

5. Treatment:-
Treatment protocol for CLARE includes immediate and temporary discontinuation of
contact lenses and anti-inflammatory medicine (eye drops). An antibiotic drop may also
be prescribed If there is also a disruption of the corneal epithelium.
For CLARE and CLPC, adding a topical steroid such as prednisolone acetate 1% can
be helpful (in the absence of epithelial defects). These are often prescribed four times
daily and tapered as the inflammatory reaction shows signs of improvement.
More symptomatic patients can be prescribed a topical cycloplegic and/or a topical or
oral NSAID to improve comfort. If an anterior chamber reaction is present along with
the infiltrates, a topical steroid may be considered to decrease inflammation and
improve comfort.