A 45-Year-Old Male with Sudden Eye Pain

Differential Diagnosis

• Blepharitis
• Contact lens solution toxicity
• Corneal foreign body
• Herpes simplex virus keratitis

Diagnosis
This patient is experiencing contact lens solution toxicity—a diagnosis that could be missed if he wasn’t questioned as to contact lens use.

Learnings

• This toxicity is often associated with improper contact lens wear or poor contact lens hygiene
• There are two types of contact lens toxicity:
  • The more common form is caused by contact lens overwear (often sleeping in contact lenses), leading to corneal hypoxia. This will lead to rapid decline in vision associated with ocular pain, redness, and light sensitivity. Chronic hypoxia may cause corneal scarring and vascularization
  • The second type has been classically associated with the preservative thimerosal, but can be seen with any contact lens solution. Patients will complain of ocular discomfort and foreign body sensation

Pearls for Urgent Care Management and Consideration for Transfer

• The patient should be advised to wear his glasses instead of contact lenses pending ophthalmology follow-up
• Supportive care includes cold compresses for itching and swelling; warm compresses for aching, pain, or discharge; rinsing the eye(s) very gently with cool water; and avoidance of rubbing the eyes