VOLUME 2, NUMBER 1
MAY 9, 2011
IF A PATIENT PRESENTS COMPLAINING OF CL INTOLERANCE, DON'T FORGET TO LOOK AT THE ENDOTHELIUM!
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When a patient starts to notice a dramatic decrease in contact lens wearing time or becomes more symptomatic when wearing their lenses,
many doctors may be inclined to change the lens or the solution. And although that is a good idea in cases where few clinical findings
are identified, it is always most important to determine the potential causes and treat them first.
Some key causes of contact lens intolerance include lid margin disease, such as meibomian gland dysfunction, dry eye disease and
ocular allergy. But, one additional—and often overlooked—cause is endothelial stress.
This specular microscopy image of a normal healthy 35-year-old female with 25+ years of daily contact lens wear (including long bouts
of overnight wear) reveals polymegathism (high rate of change in the cells size) and pleomorphism (fewer cells that are the optimal
six-sided shape). After a hiatus from contact lens wear and switching her to a higher DK lens, the endothelium improved dramatically and
so did her contact lens wearing time.
"An honorable defeat is better than a dishonorable victory."
–Millard Fillmore
