Cornea
Contact Lens Acute Red Eye
Also known as: CLARE, contact lens acute red eye, CL acute red eye, contact lens overnight red eye, extended wear keratitis, CL diffuse infiltrates, contact lens infiltrative keratitis, contact lens reaction overnight
Filed as: Soon
Source-cited from the record's own evidence list. Clinical content programme led by Dr Ankit Mathur, PhD, Grad Cert Ocu Thera, B.S. Optom. How the clinical content is governed
Clinical decision support only
Overview
An acute, painful, red eye occurring in contact lens wearers, typically during overnight or extended wear. Characterised by multiple small peripheral corneal infiltrates with conjunctival injection. Believed to result from an inflammatory response to Gram-negative bacterial toxins (Pseudomonas, Serratia marcescens) trapped under the lens. Distinct from CLPU (single large infiltrate) and bacterial keratitis (dense large central ulcer). Self-limiting but requires lens cessation.
Recognition
Symptoms: what patients report
- Acute onset of a painful, red eye on waking — typically after overnight contact lens wear.
- Foreign-body sensation.
- Tearing.
- Moderate photophobia.
- Onset on waking with lens in place.
- History of overnight or extended contact lens wear.
Signs: what the examination shows
- Diffuse or multiple small (< 1mm) peripheral corneal infiltrates — bilateral or unilateral.
- Diffuse conjunctival injection and lid oedema.
- Minimal or no fluorescein staining of the infiltrates.
- Anterior chamber: quiet or minimal reaction.
- No significant mucopurulent discharge.
- No central dense corneal ulcer.
- Signs typically begin to resolve within hours of lens removal.
What OptoGuide™ covers for contact lens acute red eye
- Pattern reasoning: what this combination of findings points to, and its differentiators
- Don't-miss risks and escalation triggers
- Management tiers with linked Australian therapeutics
- Referral urgency, specialty, and letter drafting
Sources
- Keratitis, CL-associated infiltrative — College of Optometrists CMG
- Anterior Eye Disease and Therapeutics A-Z (Bruce & Loughnan) — standard reference text
- Infectious Keratitis in 2021. Durand ML, Barshak MB, Chodosh J. JAMA. 2021;326(13):1319-1320.
- Advances in Medical and Surgical Management of Acanthamoeba Keratitis: A Comprehensive Review. Azzopardi M, Chong YJ, Smith EP, et al. Clinical Microbiology Reviews. 2026;39(3):e0027725.
- Differential Diagnosis of Microbial Keratitis and Contact Lens-Induced Peripheral Ulcer. Aasuri MK, Venkata N, Kumar VM. Eye & Contact Lens. 2003;29(1 Suppl):S60-2; discussion S83-4, S192-4.
Standard texts: Kanski's Clinical Ophthalmology: A Systematic Approach, The Wills Eye Manual, Oxford Handbook of Ophthalmology, Oxford American Handbook of Ophthalmology, Signs in Ophthalmology: Causes & Differential Diagnosis.