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We describe 4 patients who developed an acute bilateral microcystic corneal epitheliopathy with a marked reduction in visual acuity after using daily wear soft contact lenses. The cysts cleared over a period of 4 weeks with complete visual recovery, although 1 patient developed central corneal flattening. Examination of an epithelial biopsy specimen from 1 patient was negative for Acanthamoeba . However, apoptosis was demonstrated by staining with TUNEL (TdT-mediated dUTP nick-end labeling) assay . We believe that this phenomenon is the result of acute corneal hypoxia.
Epithelial microcysts are small (15- to 50-µm) inclusions previously described as a delayed response to extended contact lens wear.1 They have been noted less frequently after daily wear soft or rigid contact lens wear. Patients using extended wear soft lenses typically develop microcysts after 4 to 8 weeks. The number of cysts that develop is related to the oxygen permeability of the lens and the duration of wear, and they take several months to disappear after discontinuatiuon of lens wear. They typically occur in small numbers in the center or the midperiphery of the cornea and rarely produce symptoms. In contrast, we describe 4 patients who wore daily wear soft contact lenses who developed an acute reduction in vision associated with a gross microcystic epitheliopathy. The clinical features and the possible origin of this condition are discussed.
Tuft SJ, Luthert P. Acute Microcystic Corneal Epitheliopathy After Daily Soft Contact Lens Wear. Arch Ophthalmol. 1998;116(6):810–812. doi:
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