WHEN IS AN ULCER NOT AN ULCER?

Title WHEN IS AN ULCER NOT AN ULCER?
Author, Co-Author B.A. Holden, R. Madhukar, R. Buddi, P. Sankaridurg, D.F. Sweeney, M.D.P. Willcox, C.A. Morris
Topic
Year
1996
Day
Sunday
Program Number
2:40 pm
Room
Southern Hem III
Affiliation
Cornea and Contact Lens Research Unit
Abstract One of the most common and worrying side effects of extended wear of hydrogel lenses is the contact lens induced peripheral ulcer (CLPU). It is often confused with a microbial infection and therefore causes considerable alarm. We have, for some time, considered it to be an inflammatory rather than infective condition because of the lack of some critical features of infected ulcers (raised edges of the lesion, anterior chamber flare, eyelid and conjunctival edema, bacteria in the scrapings) and also because of the rapid recovery without treatment. Nevertheless, CLPUs have many of the characteristics of an ulcer including scarring. In this CCLRU-LVPEI study, patients were fitted with hydrogel lenses for extended wear and followed for 12 months. Several patients developed signs and symptoms typical of a CLPU: a single, full thickness epithelial lesion with a round 'white' underlying focal stromal infiltrate (1 to 2mm in diameter) with sectoral diffuse infiltration. Typically patients experienced pain, photophobia, lacrimation and severe redness. Eyelid and conjunctival edema were minimal and flare absent. The assessment of the eyes of these patients will be discussed in detail, as will the aetiology of the condition. Our hypothesis is that CLPU is caused by a bacterial by-product that activates proteases either directly or through antigen-antibody complexes without the cornea becoming infected (similar to marginal ulceration).
Affiliation of Co-Authors Cornea and Contact Lens Research Unit, L V Prasad Eye Research Institute, Cornea and Contact Lens Research Unit, Cornea and Contact Lens Research Unit, Cornea and Contact Lens Research Unit, Cornea and Contact Lens Research Unit
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