One commonly cited cause of CLARE is colonization of the lens surface with gram-negative bacteria, specifically H. General risk factors include wear of high water content lenses, wear of tight fitting lenses and history of a recent upper respiratory tract infection. While the etiology of CLARE is not completely understood, it is generally classified as an inflammatory event of the cornea and conjunctiva. Note, however, that there are reported cases of CLARE occurring with well-fit contact lenses showing adequate movement.
If you are able to assess the lens on-eye, pay special attention to lens movement and push-up test results. In the absence of a lens fit evaluation, history questions regarding hours per day of lens wear and difficulty with lens removal at the end of the day may assist in diagnosis. 7-9 Reports have also linked CLARE to extended wear gas permeable (GP) lenses, high oxygen permeability silicone elastomer lenses and overwear of daily disposable soft contact lenses. 1,6 CLARE has been reported to occur in 34% of continuous wear hydrogel lens patients and less than 1% of silicone hydrogel extended wear patients. However, note that CLARE can also be caused by extended wear of silicone hydrogel lenses, which have significantly risen in market share in the United States in the last decade. Conventionally, CLARE is associated with tight fit or poor movement of extended-wear, low oxygen permeability, high water content hydrogel lenses. Knowledge of the patient’s habitual lens type and wearing schedule may also have some value in our diagnostic considerations. So, consider asking all your contact lens patients how many times per week they sleep or nap in their lenses as part of your routine history sequence.
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2,3 This can be anything from a short afternoon nap to a full night of extended wear-the fact that the eye is closed for an extended period of time is key to our diagnosis. By definition, CLARE is associated with sleeping while wearing contact lenses. Typically, the most reliable way to accurately diagnose CLARE is with a complete case history and assessment of the symptoms mentioned above. (Case and photo courtesy of Kelli Theisen, OD.) After a 10-day course of tobramycin/dexamethasone suspension QID and preservative-free artificial tears every hour for relief, he reported a significant improvement in symptoms. He noted associated blurry vision, foreign body sensation and photophobia. 5Īcute contact lens-associated red eye presentation in a 28-year-old Indian male. influenzae were more than 100 times as likely to have had a CLARE or infiltrative response than those subjects who were not colonized with this bacterium. 1,2 One study found that patients who were colonized with H. Often, upper respiratory tract infections are associated with gram-negative organisms like Haemophilus influenza. It is prudent to ask patients presenting with CLARE symptoms about any recent illnesses, including symptoms of the common cold such as headache, fatigue and runny nose. 3,4 In more severe cases of CLARE, corneal edema or anterior uveitis may also be present, although these signs are not common. The infiltrative reaction is generally located in the corneal periphery and mid-periphery when sodium fluorescein stain is instilled in the eye, the infiltrative areas do not typically exhibit overlying punctate staining, indicating minimal epithelial involvement. Accompanying slit lamp signs include diffuse conjunctival and limbal hyperemia, as well as the presence of multiple corneal epithelial and subepithelial infiltrates. While treatment is relatively straightforward, episodes of this condition can recur thus, our job as clinicians is not only to treat the condition in its acute stage, but also to educate the patient and give them the tools to return to lens wear in the healthiest possible manner.ĬLARE is typically characterized by sudden onset of unilateral eye pain, photophobia, epiphora and ocular irritation. Often, the patient will present to your practice wearing dark sunglasses or clutching a box of tissues in an effort to cope with their symptoms. It is also commonly referred to as acute red eye or tight lens syndrome. The clinical entity known as contact lens-induced acute red eye, or CLARE, is an inflammatory reaction of the cornea and conjunctiva associated with overnight contact lens wear.
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