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How to manage patients with Limbal Redness (Limbal Hyperaemia)

Published on Jun 5, 2018
13 Minutes Read

What you need to know

Slit Lamp Viewing:

• Diffuse beam • Direct illumination • Medium magnification (16x)


  • Position: superior, nasal inferior, temporal
  • Grade 0: None
  • Grade 1: Slight injection of limbal vessels
  • Grade 2: Mild injection
  • Grade 3: Moderate injection
  • Grade 4: Severe injection



  • True incidence unknown although common in most lens types. Occurs to some degree with all hydrogel lenses, although may be mild with thin, mid-water hydrogels.


  • Short-term clinical sign of corneal hypoxia –related to oxygen performance of lens
  • Inflammation (tight lens syndrome)
  • Mechanical irritation (trauma, poor lens fit)
  • Atopic/allergic reaction
  • Solution sensitivity
  • Infection


  • Often none; depends on cause
  • Possible pain


  • Engorged limbal blood vessels with possible subsequent neovascularisation
  • May be localised or full coverage, depending on lens type or aetiology, with conjunctival vessel involvement

What you need to recommend to your patients


  • Manage if ≥ grade 2 or if ≥ 1 grading scale interval increase or if symptoms occur
  • Cease lens wear until resolution. Refit with higher oxygen performance lens materials (Silicone Hydrogel (SiHy), higher Dk/t hydrogel, rigid corneal lenses (RCL))
  • Reduce wearing time or change to Daily Disposable (DD)
  • Optimise lens fit
  • Remove allergen
  • Change care system


  • Good – depends on cause
  • Reversible
  • Noticeable “white-eye” difference between SiHy and traditional hydrogels

Differential Diagnosis:

Neovascularisation, superior limbic keratoconjunctivitis (SLK), keratitis, CLARE or tight lens syndrome, uveitis, acute glaucoma, intra-ocular infection

Further reading

  • du Toit R, et al. Recovery from hyperemia after overnight wear of low and high transmissibility hydrogel lenses. Curr Eye Res 2001; 22: 68 73
  • Papas E et al. High oxygen-transmissibility soft contact lenses do not induce limbal hyperemia. Curr Eye Res 1997; 16 (9): 942-948
  • Papas E. On the relationship between soft contact lens oxygen transmissibility and induced limbal hyperaemia. Exp Eye Res 1998; 67: 125 31
  • Papas E. The role of hypoxia in the limbal vascular response to soft contact lens wear. Eye Contact Lens 2003; 29: S72-4; discussion S83-4, S192-4
  • Pritchard N et al. Ocular and subjective responses to frequent replacement of daily wear soft contact lenses. CLAO J 1996; 22(1): 53-59
  • Pult H et al. Limbal and bulbar hyperaemia in normal eyes. Ophthalmic Physiol Opt 2008; 28: 13-20
  • Szczotka-Flynn LB et al Contact Lenses Manufactured in Etafilcon A Are Noninferior to Two Silicone Hydrogel Lens Types With Respect to Hypoxic Stress. Eye & Contact Lens 2018;44:190-9

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Important Safety Information:

ACUVUE® Contact Lenses are indicated for vision correction. As with any contact lenses, eye problems, including corneal ulcers, can develop. Some wearers may experience mild irritation, itching or discomfort. Contact lenses should not be used in case of eye infections or any other eye conditions, or in case of a systemic disease that may affect the eye. For detailed product information, including contraindications, precautions and adverse reactions, please consult the Instructions for Use or visit our Johnson & Johnson Vision website: