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James Dugas, OD and Associates

Optometrists in Austin Texas
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Clinical Photos, Common Occurrences with Contact Lenses and Injury
These photos represent the most common medical conditions that we and many eye doctors routinely diagnose and treat related to the cornea and contact lenses.
1) Normal Eye
Upper Left: Cornea is clear without any grayish spots (infiltrates) or staining.
Upper Right: Tissue on under side of upper eye lid (palpebral conjunctiva) is normal and is smooth, pinkish, and without bumps (papillae) associated with giant papillary conjunctivitis (GPC).
Lower Left: Reflection on cornea demonstrates a normal epithelium without distortion.
Lower Right: Corneal Topography Reflections on cornea demonstrate a normal epithelium without distortion. 
2) Corneal Staining due to allergic sensitivity to disinfecting solution 
Corneal Staining with Sodium Fluorescein secondary to allergic sensitivity to multi purpose disinfecting solution.  Note the pattern of staining (green spots) on the outer layer of the cornea (epithelium).  These are damaged cells.  This patient complains of discomfort and blurry vision. This condition will resolve and the staining will go away within a few weeks after changing to a different solution.  If due to suspected sensitivity of solution, our treatment would be to discontinue contact lens wear until staining is gone, and then resume contact lens usage with Clear Care disinfectant.
3) Corneal Infiltrates due to allergic sensitivity to disinfecting solution 
This is Corneal Infiltrative Keratitis secondary to allergic sensitivity to multi purpose disinfecting solution.  Note the grayish spots on the cornea.  This patient complains of discomfort and blurry vision. This condition will resolve after changing solution or discontinuing contacts.  Sometimes it may takes weeks or months for this to resolve and for the cornea to become clear again.  Treatment would be to discontinue contacts until resolved, and then change disinfecting solution.  We may prescibe an antibiotic eye drop if epithelium is damaged.
4) Giant Papillary Conjunctivitis (GPC)
Is a slowly developing allergic reaction to soiled contact lenses which are used for more than recommended intervals.  This is why disposable lenses were developed and why you are supposed to replace them on a frequent basis.  This condition will resolve and the tissue (palpebral conjunctiva) will become smooth and pink again (see photo 1) if lenses are not worn or if this patient replaces their lenses more frequently as recommended by the FDA.  This was very common 20 years when patients were using "traditional soft contact lenses". which have been replaced by disposables.  The intent of disposable soft lenses was to reduce the incidence of GPC.  However, we are seeing more GPC because patients are using disposable contact lenses beyond the recommended replacement intervals.  GPC is a valid argument for prescribing single use 1-Day Disposable Lenses, or reinforcing to patients to replace their lenses frequently, and not overuse each pair. 
5) Corneal Abrasion Due to Foreign Body
Particulate matter which became lodged in the eye or under the eyelid, and subsequently scratched the cornea.  It could be sand, metal, or a piece of sheetrock.  The Doctor usually diagnoses it based upon the activities the patient was involved prior to the complaint.  Something got in their eye, and became lodged between their contact lens and the cornea, or became attached to the underside of the upper eye lid and repetively scratched the cornea with each blink. In the photo below, the vertical, and up and down orientation of the scratches are classic for this diagnosis.  The greenish appearance of the photo is due to sodium fluorescein which we instill to help diagnose such problems.  This patient is in pain and requires an antibiotic as prophylaxis to prevent infection of the corneal epithelial wound or damage.  In more severe cases, such as a paper cut, we would have them wear a contact lens as a "bandage lens" until the wound heals.  After that we would inform them of the possibility and symptoms of a "recurrent corneal erosion" which may occur after a corneal injury, and necessitate further treatment.   
6) Corneal Ulcer 
A corneal ulcer is an injury to the epithelium of the cornea and is considered an ocular emergency.  A corneal ulcer causes pain, discomfort and, in many cases, blurry vision.  The reason patients consult us is usually because of the pain.  The most common reason that patients present with a corneal ulcer is that they slept in their contacts.  The treatment for a corneal ulcer is to discontinue contact lens usage, and prescribe an antibiotic.  The patient must be compliant and not use contacts on the affected eye for up to 3-4 weeks.  The highly magnified photo below is from a biomicroscope that we use to diagnose such problems.  Note the round spot, which is the marginal corneal ulcer. 
7) Neo-Vascularization of the Cornea.
New blood vessel in-growth to the cornea in response to using lower oxygen contact lenses.  The cornea receives its oxygen supply from the air in front of the cornea.  When it is covered by a contact lens the oxygen supply is reduced and the cornea responds by suppying new (neo) vessels to deliver more oxygen. This occurs more often when patients sleep in contacts and is why silicone hydrogel lenses are better because the are more oxygen permeable.
Photo Courtesy of Dr. Dina Miller
8) Corneal Foreign Body, Metal
Note the brown spot on the right side peripheral cornea.  This usually occurs as a result of grinding, welding, and hammering metal.  The metal particle has become brown due to it rusting and needs to be removed because it is toxic to the cornea.
 Photo Courtesy of Review of Optometry
Photos Courtesy of Bausch & Lomb, Dr. Dina Miller, Review of Optometry Handbook of Ocular Disease Management
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed optometrist or ophthalmologist professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any links to this page or other sites are provided for information only, they do not constitute endorsements of those other sites.