Acute red eye in contact lens users: Clinical pearls for frontline clinicians

Area of Science:

• Ophthalmology
• Emergency Medicine
• Primary Care

Background:

• Contact lens wear is prevalent, leading to frequent acute red eye presentations in non-ophthalmology settings.
• Limited access to specialized equipment and expertise challenges accurate diagnosis of red eye in these primary care environments.
• Acute red eye in contact lens users can range from noninfectious inflammation to sight-threatening microbial keratitis.

Purpose of the Study:

• To provide practical, evidence-based guidance for non-ophthalmologist clinicians managing acute red eye in contact lens wearers.
• To improve the triage and timely referral of patients with potential microbial keratitis.
• To reduce avoidable corneal morbidity and visual loss, especially in underserved areas.

Main Methods:

• This is a review article, synthesizing existing evidence and clinical guidelines.
• Focuses on practical diagnostic and management strategies for frontline clinicians.
• Highlights key considerations for differentiating infectious from non-infectious causes of red eye.

Main Results:

• Early microbial keratitis can present with subtle signs, necessitating high clinical suspicion.
• Timely ophthalmology referral is critical for suspected microbial keratitis.
• In specific scenarios where prompt specialist evaluation is uncertain, empirical broad-spectrum topical fluoroquinolone therapy may be indicated.

Conclusions:

• Clearer guidelines are needed for non-specialist clinicians managing contact lens-related red eye.
• Prompt recognition and appropriate management of microbial keratitis are essential to prevent severe visual impairment.
• Addressing access barriers in underserved settings is vital for equitable patient outcomes.