CLINICAL

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Prepare for C.L.A.R.E.

Ready your practice for this contact lens problem, so you can get patients healthy and back in their lenses

JOSH JOHNSTON, O.D., ATLANTA

All it takes is one “scary” experience for a contact lens patient to permanently discontinue wear, and contact lens acute red eye, or C.L.A.R.E., can certainly do it. As a result, it’s essential optometrists are equipped to manage and alleviate this condition fast.

Here, I discuss the etiology, symptoms, clinical signs, management options and ICD-9 or CPT codes associated with C.L.A.R.E.

Etiology

The exact etiology of C.L.A.R.E. is not entirely understood, but there are many risk factors that play a role. These risk factors include hypoxic corneas from tight-fitting contact lenses, sleeping in contact lenses that are not approved for overnight wear and wearing contact lenses past their intended replacement schedules.

Other causes include mechanical trauma to the corneal surface from wearing contact lenses, gram (-) endotoxins on the corneal surface from bacteria, tear debris causing toxic reactions and sensitivity to solutions,as well as immune inflammatory responses from decreased oxygen.

This patient had classic sub-epithelial sterile infiltrates in the mid periphery near the limbus.

Symptoms

► Unilateral pain upon waking

► Foreign body sensation

► Tearing

► Photophobia

Clinical signs

► Sector or circumferential perilimbal injection and hyperemia

► Mid-peripheral sub-epithelial sterile infiltrates

► Corneal edema

► Anterior chamber cell and flare (smaller extent)

Management options

C.L.A.R.E. management is comprised of the following:

► Contact lens removal. This should be immediate with the temporary discontinuation of contact lens wear.

► Artificial tears. These can be prescribed with frequent dosing (at least every two hours).

► Topical NSAIDs, steroids and cycloplegia daily for 5-7 days.

► Topical antibiotics or combination drops.

► Re-educating the patient on proper contact lens wear.

Future treatment options

Someday, we may be able to treat our C.L.A.R.E. patients with currently available therapeutics that will have modified vehicles and improved delivery systems.

These include punctal plugs that deliver steroids to relieve pain and inflammation. These plugs are currently going through FDA testing for the approval of treating pain and inflammation after ocular surgery.

Bottom line

With a fast diagnosis of C.L.A.R.E., the treatment regimen outlined and reinforcing patient education about proper contact lens wear, you can get these patients back in their lenses fast, enabling them to resume the freedom of spectacle-free vision and you to maintain a healthy contact lens practice. OM

Dr. Johnson practices at Georgia Eye Partners. He focuses on ocular surface disease and has extensive experience in comanaging cataract and refractive surgery patients. E-mail him at drj@gaeyepartners.com, or send comments to optometricmanagement@gmail.com.