title: Acute rigid gas permeable contact lens intolerance.
abstract: Rigid gas permeable (RGP) and polymethylmethacrylate (PMMA) lens wearers occasionally report episodes of acute intolerance which is experienced upon lens insertion. In this paper, we report two cases of such intolerance in which the probable cause was contact lens inversion. We also present the results of a study in which a custom-built calibrated strain gauge was used to measure the force in Newtons (N), required to invert RGP lenses [oxygen permeability, or Dk, values between 30 and 90 x 10(-11) (cm2/s) (mlO2/ml x mmHg)] and PMMA lenses of different spherical back vertex powers (+/-3.00 D, 9.00 D). Significantly, less force was required to invert minus powered lenses (17.5 +/- 4.8 N) than plus powered lenses (31.7 +/- 7 .4 N), irrespective of the material. PMMA lenses required more force to induce inversion than that required to invert RGP lenses. Lenses with a Dk of 90 required only two thirds of the force (20.0 +/- 5.8 N) required to cause inversion compared to PMMA lenses (32.9 +/- 11.0 N). High powered PMMA lenses were found to be more likely to fracture on inversion than any other lenses tested. The force required to return negatively powered lenses to their original shape, once inverted, was less than 25% of that initially required to induce inversion. Plus powered lenses either reverted to their original form spontaneously, or required less than 3% of the original inversion force to do so. It was concluded that practitioners should consider inversion as a possible reason for otherwise unexplained, acute RGP contact lens intolerance experienced upon lens insertion. The reason why inversion has eluded so many, as a possible cause of intolerance, is likely to be because minimal force is required to return those lenses, which do not crack or fracture, to their original shape.
authors.affiliation: Department of Ophthalmology, The Royal Victoria Hospital, Belfast.
authors.forename: A J
authors.initials: AJ
authors.lastname: Jackson
authors.forename: C
authors.initials: C
authors.lastname: Wolsley
authors.forename: J L
authors.initials: JL
authors.lastname: Briggs
authors.forename: D G
authors.initials: DG
authors.lastname: Frazer