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Comment by piptastic | Hacker News Reader

I had acanthamoeba in 2001.

You pretty much have to have a corneal abrasion (scratch) before introducing the eye to water. It's not something you're going to get randomly from taking a shower or swimming. However, wearing contacts regularly for the last twenty years, I tend to get an abrasion once every two years or so. I'm extra careful during these times..

In 2001, there were about 7 cases in the US per year. It took me 6 months of excruciating pain and three eye doctors just to diagnose it. Luckily the third doctor really knew what he was doing. He diagnosed it in about 2-3 visits, snuck me some non-FDA approved drops with chlorine in them, and got rid of the infection.

I had to do a corneal transplant and still can't see very well out of it - cloudy with an astigmatism too large to correct.

Here's a good resource: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3972779/

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Hello pietistic, I'm the person in the piece, I hope you don't mind my responding to you directly. I'm sorry you had AK, and I hope you're doing better now. Just to be clear, swimming in contact lenses is an incontrovertible risk factor for AK- several studies have proved this. Moorfields Eye Hospital are also concluding a case control study which will also identify showering in contact lenses is a risk factor. Here's professor John Dart from Moorfields Eye Hospital talking about these risk factors https://www.youtube.com/watch?v=neUYomeUkYM. Any questions let me know. thanks!

I had a relatively minor eye infection a few years ago, but wanting to prevent something worse, had switched to wearing contacts only for special occasions and... swimming.

Thanks to your sharing, I will no longer swim with them. I'll try prescription goggles instead.

Jesus, I even swim in lakes with mine in. Guess I'll be seriously looking at the the risks+cost of laser vision correction versus contacts in the near future. And switching to daily disposables in the meantime. I've worn them for 15 years and am not very careful, it's a miracle I haven't had any infections of any sort yet, I guess.

Getting LASEK was one of the better decisions I've made in life. The risk of infection is extremely low for the procedure but you need to be extra careful while you're healing. It may not be worth the price if your vision is currently not that awful, however.

According to this article: http://www.npr.org/templates/story/story.php?storyId=6305599

there is a 1 in 100K chance of serious complications for modern LASIX requiring corneal transplant. That's a higher incidence than the chance of getting AK if you wear contact lenses.

Both are terrible complications but I don't see the rationale of avoiding AK by getting LASIX. I couldn't find any literature but it seems to me that the fact that LASIX damages the cornea for a time would also leave one open to an infection in addition to the complications.

Yeah, but the risk from contact lenses comes over time as it's a risk every time you put your lenses in where with laser correction the risk pretty much only exists while you are healing. You really only have to avoid getting stuff in your eye while the bandage lens is in.

Everything I've read about comparing the risk notes this factor.

I'm sure that if you wear contacts perfectly all the time the risk is very low, but as we all know people do stupid things.

That said, the decision to get surgery was more about not having to deal with glasses or contacts every day and less about the risk.

Speedo makes swim goggles with corrective lenses that are not prescription. Think "reading glasses" but available in much higher strengths. http://www.speedousa.com/vanquisher-optical-goggle-style-750...

Thanks for that. I have prescription googles, but their seal sucks when compared to my (quality) regular googles. So will try these instead!

Just wanted to say that the work you've done is really impressive and inspiring. As a contact lens wearer, I just learned about AK thanks to you. Good on you for taking the initiative to be a force for positive change.

I don't mind you replying, it's no problem. Thanks, I'm sorry you had it too.

Can you link me to one of the several studies proving the incontrovertible risk factors for swimming?

Anecdotally, I agree: it can't be that easy. I've worn contacts for most of my life (including while doing competitive swimming, showering, etc), and recently (3 years ago) got into scleral lenses (which included instructions from my optometrist to rinse these contacts in cold water to rid them of preservatives). If the formula really was "tap water and mis-care of contact lenses induces eye infection", I would have been blind before I could vote.

Maybe I'm just that lucky. A shame my lottery tickets disagree.

> Anecdotally, I agree: it can't be that easy.

Not to be too dismissive about your experiences, but making medical-related decisions based on anecdotal evidence is a really bad idea -- the debate over vaccines is a good example of this IMO.

Have a look at reenw's numerous comments in this thread for references to sources/studies that suggest that it can be that easy...

Acanthamoeba is an amoeba that lives in the water. So yes, it's tap water plus handling your contacts in the same way that touching a door knob can give you a cold. Just because you've touched door knobs without getting a cold doesn't mean you shouldn't wash your hands.

It's not the lottery, that's how infections work.

>if "tap water and mis-care of contact lenses induces eye infection", I would have been blind before I could vote.

Tap water and mis-care of contact lenses induces significantly elevated risks of eye infection. Your lottery ticket comparison is apt, since as the article and some other comments here reflect, you are gambling your sight with this attitude. Same one everyone hears from the guy who doesn't wear glasses while he's running a lathe. The difference being, at least that guy can argue his skill reduces his risk of injury.

Would it be wise to stop looking both ways before crossing the street because the first three times you tried it you weren't struck by a car?

No, but if I haven't been struck in the more than 8,300 times I've done it previously, I might have a more lax attitude. Especially when changing habits also includes a fairly major dollar cost.

All that said, after reading a number of different resources, I am considering such a change.

That seems hard to believe that an optometrist would recommend rinsing your lenses with anything other than sterile saline.

They did. Reading through many other resources online, it does seem like a change in regimen would be warranted, however.

A shame, preservative free saline is expensive.

I've had one due to dropping some stucco into my eye when working on a ceiling, before I realized what happened my eye had rotated causing some pretty deep scratches. Both extremely painful and took surprisingly long to heal.

I tried contacts twice, a few years apart. On both occasions, a few weeks in, I ended up sitting in front of an opthalmologist having had what seems to have been a corneal abrasion from the contact lens. The opthalmologist couldn't find anything wrong, and I can only guess that maybe a dry eye caused the lens to stick to both the ball and lid, then moving the lid yanked the lens and in turn the ball. Seriously sharp pain and eye streaming.

This is scary, I have 1 month disposables but use them for 1-3 months, I always insert them with wet hands, I shower with them on most days, I swim at the gym with them but use goggles. I've been doing this for the last 14yrs, time to change my habits!

If I understand correctly, you have to have an open wound for this to occur?

How can you tell that you have a corneal abrasion?

It's can be quite unpleasant. The test for it is very straight forward - eye drops and someone looks into your eye. Wear goggles when grinding steel and even if you do, take care when washing your face afterwards. Steel stuck in your cornea, cutting your eyelid when blinking is terrible.

> Wear goggles when grinding steel and even if you do, take care when washing your face afterwards.

Go one further: Goggles and a face shield, minimum. Why?

Have you ever had a right-angle grinder wheel explode? I have (it was actually a cut-off wheel). At the time I wasn't wearing even goggles, just my eye glasses. Amazingly, nothing hit me in the face, but I do remember hearing the part ricochet around my friend's shop (fortunately, I was the only one in it at the time).

Unfortunately, a piece hit my knuckle - extremely hard; I thought I had lost my finger, but amazingly not (oh, I wasn't wearing gloves, either).

I should've got stitches, but my friend took care of it; we washed it out, wrapped it up, then he gave me a percocet to take the edge off the pain. I remember at one point we looked at it after it had been a few hours, to see if I could still move it; I started to flex it, and had a small Monty Python flesh-wound moment (seriously, it made me laugh it was so cliche looking - though completely real); but I could move it. All's good today, still typing with it!

Basically me doing everything wrong (it really was all my fault, I shouldn't have been handling that equipment - I think I was also wearing shorts, a t-shirt and open-toe sandals at the time - a total DERP moment, but that's all it took), I knew better even then, but I was stupid that day. Faster than you can blink, bam, and there it was.

I take a lot more precautions now before I handle spinning cutting/grinding shit moving at 20k RPM (though I am still not a fan of my friend's open-guard 9 inch grinder - the thing will grind anything off anything, but holy hell is it dangerous to use - if that thing let loose, no amount of safety equipment will save you).

Oh - and if you are arc welding, don't wear a white shirt; reflection of the arc can bounce off inside your helmet, and still cause "welder's blindness" - which is basically a nice sunburn to the cornea; generally not a permanent thing, but hurts like hell for a long while.

Also, use a guard on angle grinders! And keep it in between you and the work! A man was killed by an exploding cutting disk at a company I used to work at. Shrapnel lodged in his chest, he took the guard off to get at something more easily.

Yes. It's a tradesman hack to buy a 115mm grinder (it's cheap), take off the guard and fit 125mm disks. People have been killed here recently by broken bits firing out. Cutting disks are so thin that a minor course correction can easily break them. Someone I know had a labourer use a grinder with a broken on off switch. One day the guy put it under his arm and plugged it in, and it cut through artery, vein and nerve. A year later and he is just starting part time work.

If you had one and you didn't know, I'd be amazed. In my experience, it is incredibly painful.

I accidentally scratched my eye with a fingernail once.

Severe pain, eye constantly watering for a couple weeks.

I've been wearing contacts for over 20 years (started in HS) and have never had a corneal abrasion. With a prescription of -8.5, I hate the tunnel-vision effect glasses give me, so I wear my contacts pretty much all the time (I don't sleep in them, however).

A coworker came into work one day with a really ugly looking right eye (red, tearing, etc.) Turns out he got whacked in the face by a tree branch on his way in (he rode his bicycle to work). He was even wearing glasses but apparently that didn't protect his eye (enough). He lasted about an hour before he left to go see his eye doc who diagnosed him with a corneal abrasion. Guy was in pain for weeks.

So my assessment is that corenal abrasions are caused by 'bad luck.'

I sleep in mine, except for once a week when I take them out to disinfect overnight or replace (I have 2-week disposables). I've had a mix of opinions from doctors on this. My current doctor says it's fine if my eyes aren't getting dry/irritated (in which case I should take them out), though I've had past doctors who were against it.

The tradeoff in the current doctor's opinion is that taking them out nightly reduces infection risk theoretically, through nightly disinfection, better access to the eye surface for your immune system, and lower risk of corneal abrasions. But handling the contacts daily for removal/reinsertion provides a new route for infection, as a lot of infections are introduced by fingers, lens cases, etc. So the added handling might offset the benefits of nightly removal enough to make it a net loss, if you're one of the people for whom sleeping in contacts doesn't produce dry eyes or irritation. Real-world data seems not good enough to compare the magnitude of those two effects.

An anecdotal word of warning: I wore bi-weekly disposables as well for quite a few years and would repeatedly sleep in them. Never had dry eyes or irritation, however after a few years I developed tiny capillaries growing in my eye (corneal neovascularization), as it turned out they were not getting enough oxygen.

Supposedly if they continue to grow I could lose my eyesight, and they won't actually go away even if I stopped wearing lenses.

Yeah, that's a good point. I've had that mentioned to me, but I get annual checkups, and have been told that they'd show up in the annual checkup if I were having that problem, at which point I could change my habits (it's not an acute condition that crops up in a month or something). Supposedly that complication has also gotten less common in the past 5-10 years as newer lens materials are much more oxygen-permeable than older ones were.

I caught my eye with the edge of a cardboard box. On the way to the hospital I had to drive into the sun. Both keeping my eye open or closed was painful.

The test they did was a couple of drops in my eye and a black-light. The end result was just a few days Vicodin script and after a couple days I was fine. The drugs didn't even reduce the pain from what I could tell. Luckily they made me tired so I slept for most of those days anyways.

Oh man, I had the same question because I got PRK and I didn't know whether or not my cornea is fully healed.

Since the pain stopped, that's that.

And everyone's stories are the same stuff as I felt PRK post-op.

Extreme pain in the eye that was just touched by an object. Pain that does not go away after a few minutes or an hour.

Generally your eye becomes red, it hurts, and is sensitive to light. There are varying degrees of an abrasion though, and the severity of these symptoms may make the less severe versions harder to determine if it's an abrasion or something else.

Paradoxically it's harder to tell when you have your lenses on. They're a barrier between the surface of the cornea and the inner eye lid so they actually mask the pain you might feel without them.

Although I wear extended wear lenses which are FDA approved to stay in for 30 continuous days my optometrist has emphasized that they need to come out every week for an evening so that you can evaluate the condition of your eyes and how your cornea is feeling. It only takes a few days to develop an abrasion that as folks have noted is very painful.

As long as I can wear lenses overnight I'm never going to try LASIX. Just too many people that run into issues with dry eyes, halos and poor night vision. Since I'd still have to wear reading glasses I don't even see the point - with my multifocal lenses I almost never wear glasses anymore for reading even.

> snuck me some non-FDA approved drops with chlorine in them

Yikes! I mean, that'd do it, but yikes.

I wonder how much chlorine it takes. Would swimming in the local pool with your eyes open help count as treatment? Probably not, the article says it's "common in tap water, sea water and swimming pools." Still.

My guess is that it was chlorhexidine drops. It's a disinfectant compound that contains chlorine, but isn't directly comparable to the free chlorine that acts as a pool disinfectant. The drops approved in Europe (and used to treat AK) are chlorhexidine 0.02%.

Chlorhexidine is a very common and essential medicine (according to the WHO, at least). It kills damn near anything microbial it touches.

This sounds right, they were sourced from the UK. Sorry, I don't remember exactly, I was much younger then.

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