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OP2202 > 5 & 6. CL Complications: Blepharitis, MGD and Papillary Conjunctivitis > Flashcards

5 & 6. CL Complications: Blepharitis, MGD and Papillary Conjunctivitis Flashcards

1
Q

Which condition Blepharitis or MGD is associated to contact lens wear and which one is caused due to contact lens wear?

A

Blepharitis: Not caused by CL wear, but cause problems with CL wear.
MGD: Caused by CL wear and cause problems with comfort.

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2
Q

What are the 2 types of blepharitis?

A
  1. Anterior blepharitis
  2. Posterior blepharitis
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3
Q

What happens in anterior blepharitis?

A

Inflammation of follicles & glands of Zeis or Moll

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4
Q

What are the 2 forms of anterior blepharitis?

A

Bacterial or seborrhoeic

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5
Q

Define what happens in posterior blepharitis?

A

Inflammation of meibomian glands

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6
Q

What is the difference between anterior and posterior blepharitis

A

Posterior is an inflammatory response. Anterior is a non-inflammatory response.

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7
Q

Why is blepharitis said to be chronic and difficult to manage?

A

It requires on-going treatment and constant medical care.

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8
Q

Staphylococcal and seborrheic are characterized by?

A

Staphylococcal: hard and brittle scales around the base of the lashes.
Seborrheic: Soft and greasy scales. Lashes are greasy and stuck together.

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9
Q

3 causes of Staphylococcal

A
  1. Direct inflammation
  2. Inflammatory rection to bacterial exotoxins
  3. Allergic reaction to bacteria themselves
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10
Q

Seborrheic is related to what skin condition?

A

seborrhoeic dermatitis and acne rosacea : Ask in H&S

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11
Q

What is meant by telangiectasia

A

Dilation and redness of blood vessels on the lid margin

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12
Q

Describe the difference seen when scales around lashes is removed from staphylococcal blepharitis vs lash mite infestation

A

staphylococcal blepharitis: bleeding observed
lash mite infestation: no bleeding observed

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13
Q

Describe what is seen in patients with seborrheic blepharitis

A

Shiny anterior lid margin, hyperemia of lid margin. Greasy scales and lashes stuck together.

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14
Q

Early signs of blepharitis

A
  1. Anterior crusting (Collarettes)
  2. Lid redness (lid erythema)
  3. Dilated lid margin vessels (telangiectasia)
  4. Lid margin swelling
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15
Q

Long standing signs of blepharitis

A
  1. Thickened lid margin (tylosis) & notching
  2. Trichiasis, madarosis, poliosis
  3. Blocked meibomian glands
  4. Corneal staining
  5. Foamy tears (saponification of tears by excess fatty acids)
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16
Q

Symptoms of blepharitis

A
  1. Soreness, redness & irritation
  2. FB sensation, dryness, itching
  3. Burning, grittiness, mild photophobia
  4. May be worse than signs
  5. May be worse in the morning
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17
Q

How is blepharitis managed?

A

Lid hygiene and warming: to loosen the collarettes, remove crusts and reduce staph levels.
Commercial products or home remedies can be used

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18
Q

Medications used for blepharitis management

A

Short course of tropical antibiotics: chloramphenicol ointment
Systemic antibiotics used in cases associated with acne rosacea
Corticosteroids: Weak tropic if severe
Artificial tears: promote comfort

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19
Q

What are the 3 consequences if patients with blepharitis wear contact lenses?

A
  1. Staph presence/infection
    = increased risk of infection
  2. Corneal staining
    = discomfort & increased risk of infection (Staining is because epithelium breaks, risking infection)
  3. Adversely affects tear film
    = dry eye, reduced comfort and wearing time (WT) (due to instability of the tear film).
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20
Q

How can blepharitis be managed if patients must wear contact lenses: 4 methods

A
  1. Lens wear management: Do not wear until advised.
  2. Increase lens replacement frequently: instead of monthly shift to dailies or weekly.
  3. Careful lens cleaning
  4. Refit with silicone hydrogel : they offer better comfort
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21
Q

Meibomian glands are modified ..?

A

Sebaceous glands within tarsal plates

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22
Q

Meibum function

A
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23
Q

Meibum function

A

Oily secretion

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24
Q

Functions of the oily secretion by the meibum gland

A
  1. Lubrication of the lid margin.
  2. Produce the outermost lipid layer of the normal tear film: to prevent tear film evaporation
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25
Q

Describe MGD, why is it caused?

A

Hyperkeratinisation of the ductal epithelium, keratinised cell debris and increased meibum viscosity

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26
Q

Is it true that MGD is the most common cause of dry eye diseases?

A

Yes

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27
Q

Risk factors of MGD

A

1.Age, gender, hormonal disturbance, systemic agents, contact lens wear
2. Secondary to skin conditions

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28
Q

What type of dry eye is caused by MGD

A

Evaporative dry eye

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29
Q

What is the definition of MGD

A

MGD is a chronic, diffuse abnormality of the Meibomian glands, commonly characterised by terminal duct obstruction and/or qualitative/quantitative changes in the glandular secretion.

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30
Q

What happens to normal oily secretions to patients with MGD?

A

the normal oily secretion becomes semi- solid, toothpaste- like plaques

31
Q

Causes of MGD?

A

Increased tear film osmolarity- this is caused hyperosmolarity and CL wear causes this. Additionally, use of a lot of electric devices: reduces blinks. Eyes become more hyperosmolar

32
Q

Signs of MGD

A

Gland plugging/capping, absent or cloudy/paste-like yellowy secretion on expression, tear foaming, telangiectasia, notching, tear film instability, often leading to corneal staining

33
Q

Describe what happens to meibomian glands in MGD?

A

The glands are dying, as they are dying they contract, pulling down on the lid margin.

34
Q

MGD is diagnosed using?

A

Meibography : evert lower eye-lids and use infra-red light and use grading scales to grade.

35
Q

In progressive meibomian gland disfunction what happens to the glands?

A

The glands become irregular cause they are dying

36
Q

Describe hoe MGD is managed in relation to Diet, work environment, eyelid hygiene, lubrication

A

Diet: food rich in omega-3 or supplements can be taken. Work environment: computer use, position and duration. Eyelid hygiene: using a warming cloth to manage and clean the lids.

37
Q

Can IPL be used to treat MGD?

A

YES, the device generates heat that liquefies the meibum.

38
Q

Relationship between CL wear and MGD

A

CL greatly affects MG morphology. CL wear can lead to partial or complete gland loss in most CL wearers

39
Q

How is MGD managed in patients that wear CL?

A

If necessary, completely cease lens wear until effectively managed.
OR:
1. Increases lens replacement frequency
2. Careful lens cleaning
3. Refit with silicone hydrogel

40
Q

Why are silicone hydrogels preferred? And what is 1 disadvantage?

A

Preferred because: lower water content, less lens dehydration so better comfort.
Disadvantage: More lipid deposits so careful cleaning needed.

41
Q

Contact lens papillary conjunctivitis is also called?

A

Contact lens induced/ associated papillary conjunctivitis. (CLIPC, CLPC)

42
Q

Describe the difference in onset in patients that wear soft lens or RGP?

A

Soft lenses: onset within a few weeks of initial wear.
RCP: Onset up to 14 months from initial wear.

43
Q

Is CLPC related to the immune system

A

CLPC, Is a non-specific immune response.

44
Q

What are the 3 reasons that cause reactions in CLPC

A
  1. Hypersensitivity: immune response to solution and deposited lenses
  2. Mechanical trauma
  3. Individual susceptibly
45
Q

Where is papillae formed for soft contact lens wearers and for RGP wearers?

A

Soft contact lens wear: Central tarsal plate. RGP: Small section 0.5- 2mm localized or randomly distributed. RGPs aggravate small areas.

46
Q

Papillae consists of what kind of tissues and what happens when this tissues become infiltrated?

A

Papillae consists of connective tissues. When this tissues become infiltrated: an inflammatory reaction is seen.

47
Q

What is seen when the blood vessels in the papillae are dilated ?

A

When blood vessels are more dilated, this allows more inflammatory cells into the area. After a long time the conjunctiva becomes thickened and changes to microvilli is seen.

48
Q

CLPC Symptoms (7)

A
  1. Acute ocular discomfort
  2. Lens intolerance
  3. Itching
  4. Mucous discharge
  5. Excessive lens movement
  6. Increased lens deposits
  7. Reduced VA & CS
49
Q

How is CLPC Seen under slit lamp (What mag is used, and what observations are done)?

A

Mag: 10-15 X
Observe CENTRAL tarsal plates, redness/ roughness. Look for conjunctival oedema and mucus formation.

50
Q

When looking for CLPC signs the upper and lower lids are compared, why?

A

The difference between the 2 is observed. Because the lower lids do not move a lot in comparison to the upper lids. Hence, when blinking the lower lids do not interact much with the contact lenses.

51
Q

What is 1 classic sign that a patient has papillae?

A

Central vascular trough. Hence, the vessel running through the centre of the papillae is dilated and hence, high mag is used to diagnose (40X)

52
Q

What 3 signs are seen if the superior cornea is affected?

A
  1. Staining
  2. Infiltrates
  3. Limbal redness
53
Q

Lids are divided into 5 zones, why?

A

Because patients might have localized papillae that looks very different in different areas.

54
Q

What zones are affected by soft lenses and RGP?

A

Soft lenses: Zone 1 and 3
RGP: Zone 3

55
Q

What is the difference in the papillae apex of patients that wear Soft lenses in comparison to RGP lenses?

A

Soft lenses: Papillae apex is rounded, flattened form.
RGP: Papillae is crater- like form

56
Q

What is seen first when lids are everted? Redness or roughness? And how are this 2 observed differently

A

Redness changes are seen before roughness changes. And redness changes are seen using white light initially. To look at roughness changes, fluoresce is used.

57
Q

How is CLPC graded? Using CCLRU and Efron, describe the difference?

A

CCLRU: Redness and Roughness is graded. Efron: pap conj is graded.

58
Q

CLPC prevalence has declined now because?

A

Good quality cleaning, deposits are no more a problem, lens do not interact with palpebral conjunctiva much.

59
Q

Effect of overnight wear and use of daily disposables in relevance to CLPC prevalence

A

Overnight wear: Increases likely hood by 2 times
Daily disposable lenses decreases likely hood to 2%.

60
Q

Recently the prevalence of CLPC isn’t high, why has there been a decline over the years?

A

Because now lenses have good cleaning product, deposits are not much of a problem now, lens do no interact with palpebral conjunctiva much. Improvement in management and disposable lenses are now available. Better CL education is now available.

61
Q

How long does it take to recover lower grade CLPC vs high grade CLPC?

A

Low grade: 1-2 weeks
High grade: Can take months to recover

62
Q

3 ways of managing CLPC?

A
  1. Cease lens wear initially if necessary: This allows time for the conjunctiva to recover.
  2. Change lens : to hydrogel or RGP, change of material, modulus and modality
  3. Change care system: check compliance, solution needs to be changed regularly.
63
Q

How can itchyness be reduced in patients with CLPC?

A

Cold compress

64
Q

Describe how lenses should be cared for for patients with CLPC?

A
  1. Hand wash (improvement to ocular hygine)
  2. Reduce wear- time
65
Q

What is the prognosis of CLPC?

A

Symptoms improve quickly after removal of lenses and once patient stops wearing lenses, but papillae takes long to resolve (2 week- 6months), lens shouldn’t be worn in this duration as papillae apex may scar giving whitish appearance

66
Q

What is differential diagnosis?

A

Through history and symptoms, the cause of a condition is determined since various problems can be causing a condition.

67
Q

Is giant papillary conjunctivitis associated with CL wear?

A

Not often, unless advanced stage

68
Q

GPC is associated with what 5 conditions ?

A
  1. Ocular prostheses
  2. Nylon sutures
  3. Scleral buckles
  4. Elevated corneal abnormalities
  5. Blebs
69
Q

Follicular conjunctivitis is what kind of an infection?

A

Viral and chlamydial infections

70
Q

What are the 3 signs observed for follicular conjunctivitis?

A
  1. Watery discharge, no mucous
  2. Slight irritation
  3. Best observed in lower fornix
71
Q

Is a vascular tuft present in follicular conjunctivitis?

A

No vascular tuff at the apex- vessels are on the outside and whiter then papillae.

72
Q

What kind of reaction is vernal conjunctivitis?

A

Allergic reaction (IgE mediated response)

73
Q

What is seen in vernal conjunctivitis ?

A
  1. Papillae on both lids, no vessels in centre.
  2. Papillae may be LARGE
  3. Thick yellow discharge

OP2202 (16 decks)

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