Living Library

Solution Sensitivity

CLINICAL DESCRIPTION:
Figure 2Figure 1 Solution sensitivity may result from toxicity to the chemical makeup of the solutions used to disinfect and wet the lens (i.e., preservatives, added surfactant), a patient's allergic reaction to the solution ingredients, using a solution inappropriately (i.e., using a cleaner or hydrogen peroxide in the eye), or solution incompatibility with a particular contact lens material. Objectively, the practitioner may note diffuse superficial punctuate staining, peripheral staining and/or injection (Figure 1 & 2). In a more severe reaction, corneal edema, chemosis and corneal infiltrates might be observed.
(Courtesy of Dr. Langis Michaud, École d'Optométrie Université de Montréal)
SYMPTOMS:
Patients may have symptoms that range from no symptoms to symptoms of burning, dryness, decreased wearing time, redness, vague lens discomfort or some combination of these symptoms. In addition, the patient may have increased tearing and photophobia if the reaction is moderate to severe.
INCIDENCE: 
Solution sensitivity can be found in gas permeable or soft lens patients. Primarily reactions are found in soft lens patients due to the nature of the lens material absorbing the solution. Some solutions have shown increased corneal staining when used with silicone hydrogel materials.
ETIOLOGY:
A patient may experience solution sensitivity as a result of an allergy to some ingredient in the solution. This can occur within minutes to days of the initial use of the solution. Over time, the preservative in the solution may build up in the lens matrix, increasing the concentration of the preservative and resulting in a toxic reaction to the cornea. Solutions demonstrate different reactions when used with silicone hydrogel materials, which have hydrophobic components and treatments to improve wettability. Studies have shown that certain solution brands combined with specific silicone hydrogel lens materials are more prone to solution-related corneal staining. Lastly, contact lens wearers will at times accidently put cleaner, hydrogen peroxide solution, or other solution not for use in the eye, on the lens or in the eye, resulting in a solution sensitivity.
MANAGEMENT:
When a patient demonstrates or complains of a solution sensitivity, the first step would be to change to a solution with a different preservative or no preservative at all. Simply changing to a different preservative may correct the problem. A better alternative is to place the patient in a non-preserved disinfection system like hydrogen peroxide or a solution-free lens, such as a daily disposable soft lens. Typically, the patient may be started on a new care regimen with a fresh lens and no loss of lens wear. In the rare case of the patient who has severe staining and discomfort, discontinuing lens wear and using non-preserved rewetting drops or gel-type lubricating drops until the cornea is healed is recommended.
KEY REFERENCES:
Andrasko G. The Staining Grid Center. http://www.staininggrid.com/ Last accessed 4/3/08.
Campbell R, Caroline P. Multipurpose non-keratitis. Contact Lens Spectrum 1997;12:56.
Carnt N, JalbertI, Stretton S et al. Solution toxicity in soft contact lens daily wear is associated with corneal inflammation. Optom Vis Sci 2007; 84:309-315.
Carnt N, Wilcox MDP, Evans V, et. al. Corneal staining: The IER matrix study Contact Lens Spectrum 2007;22(9):38-43.
Jones L. Understanding Incompatibilities. Contact Lens Spectrum Supplement 2004;19(7):4-8.
Miller MB, Dillehay SM. Multipurpose solution use with silicone hydrogel contact lenses. Contact Lens Spectrum 2007;22(5):33-40.
OTHER REFERENCES:
Andre M. Contact lens care products: problem or solution? Contact Lens Spectrum 2004; 19(7):37-40.
Carnt N, Keay L, Naduvilath T, et al. Risk factors associated with corneal inflammation in soft contact lens daily wear. Invest Ophthalmol Vis Sci 2007; 48:E-abstract 4326.
Gromacki SJ. Hydrogen peroxide disinfection. Contact Lens Spectrum 2006; 21(12):19.
Gromacki SJ. Taking a closer look at hydrogen peroxide products. Contact Lens Spectrum 2007; 22(2):26.
Mack CJ. Contact lenses 2007. Contact Lens Spectrum 2008; 23(1):26-34.
Melton JW, Phillips JH. Patient comfort comparison of hydrogen peroxide systems. Contact Lens Spectrum 1988;3(9):48-51.
Soni PS, Horner DG, Ross J. Ocular response to lens care systems in adolescent soft contact lens wearers. Optom Vis Sci 1996; 73:70-85.
Ward MA. How private-label solutions affect your practice. Contact Lens Spectrum 2006; 21(3):25.
Watanabe RK. Contact Lens Solution Update 2006. Contact Lens Spectrum 2006; 21(8):26-31.
Zigler LG. SoftWear saline and the sensitive patient. Contact Lens Spectrum 1990;5(12):50-51.

Vinita Allee Henry, O.D., F.A.A.O.
Kimberly Layfield, O.D.
Julie Ott DeKinder, O.D., F.A.A.O.

University of Missouri-St. Louis, College of Optometry