1. Aftercare Flashcards
What are symptomatic issues?
Issues seen in the eye but do not cause any problem.
What are the LOFSEA Questions?
- Location -where, which eye?
- Onset -when did it first start happening?
- Frequency -how often? Is it at the end of the day?
- Type – What type of pain, sharp or dull?
- Severity -serious pain, or neglectable pain?
- Effective treatment -what has the patient tried to solve the issue? Drops? Reduced wear time? Glasses helping or not?
- Alleviating/ aggravating factors -what has made it better or worse?
Sharp pain: might be dry eyes or dull throbbing pain indicates microbial involvement.
Patient complains of recent reduction in vision - how to check if this is a refractive cause or pathology?
Pinhole is used if px complains reduction in vision recently, to rule out refractive issue vs pathological issue of the fundus.
If a patient has never had any issues with the lenses- and this is the first time they are complaining of something- it is likely to be related to?
Related to the lens or solution rather than the eye.
“I can’t see properly in my lenses.” - What questions are asked?
- Distance or Near vision?
- One eye or both eyes?
- When did it start?
- On insertion or later in the day?
- Constant or intermediate?
- Reduced clarity or stability of vision?
- How blurry- rate vision out of 10?
- Vision with specs? -To identify if CL issue only or change in overall power.
- Any associated factors? Example when using VDU (suggests dry eye). If dry when outside on in the car- wind or air comings from the vents is the issue.
- Other symptoms?
If patient reports reduction in vision when using VDU while wearing lenses what does this suggest?
Px has dry eyes
Vision is blurry when patient blinks- what does this suggest?
Could suggest lens doesn’t fit well.
Px reports blurry vision, what is tested?
- VA
- Over-refraction
- Lens fit
- Lens condition
- Ocular health
Possible causes of reduced vision on application of lens?
- Correct eye?
- Uncorrected sphere?
- Uncorrected cyl?
- Badly fitting lenses?
- Dirty lenses?
- Damaged lenses?
- Faulty lenses?
Possible causes of unstable vision?
- Lenses inside out?- lens move rapidly.
- Poor fit? -If keratoconus, disease progressing?
- Toric swivel?- Toric lenses rotating to much?
- Over minuses? -stimulates accommodation, when accommodation relaxed, vision gone then especially at near.
- Dry lens surface?
- Dirty lenses?
- ‘Smeary’ tears? Lipid/ Mucin
Effect of over minused lenses?
Over minus stimulates the accommodation. When accommodation is tiring and px is no more accommodating than vision is affected mostly effects near vision more.
Implication of lens surface not being clean on vision?
Tears break up on lens surface and cause unstable vision after blinking.
Compliance issue- how is it resolved?
Px education
Does lens fit change over time for keratoconus patients?
Yes. As the disease progresses- lens fit changes overtime.
Vision is better after blinking- what does this mean?
Dry eye
“My vision is fine with glasses. I just can’t see with my contact lenses.” What is considered?
- Power change?
- Toric might have rotated
- Lens solution could be causing the problem
- Lens material/ modality is the problem
How to suggest a better lens for a patient?
“These lenses are more modern lenses and are designed for eyes are like yours, would you like to try them?”
“My eyes are red when I wear my lenses.”
- Unilateral/ bilateral?
- Location?- particular part or the whole eye is red?
- Onset and duration?
- As soon as the lenses go in? OR As the day goes on?
- How often? Everyday?
- How severe? – how bad is the redness? Is it really obvious?
- Associated symptoms?
- Pain
- Vision loss
- Discharge
- Photophobia
- Triggers -Hayfever is the trigger?
“My eyes are red when I wear my lenses.”- what assessments are done?
- Vision
- Lens fit/ condition.
- Anterior eye exam with NaFl and lid eversion.
- Corneal integrity – ulcer developing? scratch? lens spilt?
- Assess under the eyelids- anything trapped?
Red eye- bilateral problems could be caused by?
- Something on their hands?- soap?
- Insertion technique? – aggressive?
- Solution problem?
- Severe CLIPC?
Red eye- unilateral problems could be caused by?
- Damaged lens? – check with slit lamp, lens edge.
- Insertion technique?
- Corneal problem?
CLAPC Full form?
Contact lens induced papillary conjunctivitis
What is CLAPC?
Is an inflammatory condition of the upper tarsal conjunctiva, presenting with hyperaemia and roughness of the conjunctival surface in response to contact lens wear.
Predisposing factors of CLAPC?
- increases with duration of wear
- more common in re-useable lenses compared to daily lenses
- common in high modulus lenses- SiH –> Increase frictional irritation on tarsal plates
CLAPC Symptoms?
Itching and non-specific irritation e.g. burning, foreign body sensation.
May increase after lens removal.
- Mucus discharge
- Increased lens movement
- Loss of lens tolerance
- Decreasing comfort (may abandon wear)
- Blurred vision
CLAPC management?
Treatment for CLAPC initially consists of improving contact lens hygiene, optimising lens fit and replacing lenses more frequently. Eye drops such as anti-histamines or mast cell stabilisers are often required to relieve symptoms and improve clinical signs. In more severe cases it may be necessary to use steroid eye drops for short periods.
Acute redness (redness in one segment) is related to?
- Pointing at an infiltrate?
- Traumatic?
- Damage lens edge?
- Episcleritis?
- Subconjunctival hemorrhage?
Central epithelial problem bs periphery - why does this matter?
More central an epithelial problem is more likely it is to be MK (microbial keratitis)
Periphery it is likely to be a sterile ulcer.
Subconjunctival hemorrhage is related to ?
Systemic problems
Why does it sting when I put my lenses in?
- One eye or both eyes?
- How long does it last?
- How long has it been happening?
- Have you changed the solutions?
- Do you use hand creams?
- Fluffy towels?
- Does it resolve without contact lenses?
