What best describes CLARE?

• A. Bacterial keratitis
• B. Inflammatory reaction of the cornea to contact lens overwear
• C. Autoimmune uveitis
• D. Glaucoma

Answer: (B)

CLARE, or Contact Lens Acute Red Eye, is an inflammatory reaction of the cornea caused by contact lens overwear. It stems from hypoxic stress and mechanical irritation from the lens rather than an infection. Clinically, patients often have rapid redness, irritation, tearing, and photophobia after wearing lenses. Slit-lamp examination shows diffuse anterior corneal edema with small subepithelial infiltrates or microcysts, and there is typically no epithelial defect or purulent discharge. It commonly affects both eyes and improves quickly once lens wear is stopped.

The key distinction is that CLARE is noninfectious and resolves with removal of the lenses and supportive care (lubrication, sometimes hypertonic saline). This sets it apart from bacterial keratitis, which would present with a focal epithelial defect and a more dangerous infectious process, as well as from autoimmune uveitis or glaucoma, which involve intraocular structures or elevated intraocular pressure, not just corneal surface inflammation.