5.2.1 Flashcards
What are 6 most common conditions associated with contact lenses
Infiltrated keratitis (CL associated)
Corneal abrasion
Giant papillary conjunctivitis
Dry eye
Microbial keratitis
Acanthamoeba keratitis
What is contact lens related infiltrative keratitis and its sign and symptoms
self-limiting inflammatory response of the cornea, affecting the anterior stroma and includes CLPU and CLARE
Signs peripheral anterior stromal infiltrate(if lots then CLARE) conj hyperaemia, usually unilateral
Symptoms red eye, watering, FB sensation, photophobia
Management for CL associated infiltrative keratitis
Discontinue CL wear
If methyl then switch to daily
Evaluate lens fit and care regime
Reinforce lens hygiene
If blepharitis present then lid hygiene and cpl
What is corneal abrasion and its signs and symptoms
It is the distribution of corneal epithelial integrity
Signs lid oedema, conj hyperaemia, corneal epithelial defect, corneal oedema,
Symptoms sudden onset, pain, FB sensation, watering, blurred vision, photophobia
Management of corneal abrasion
Cease cl wear
Topical anaesthetic to aid examination
Refer to IP for levofloxacin/gentamicin (to prevent bacterial infections)
Ocular lubricants
What is CLAPC and its signs and symptoms
an inflammatory condition of the upper tarsal conjunctiva
Signs bilateral, papillae, hyperaemia, stringy mucus on tear film, conj oedema, conj surface roughness
Symptoms itching, mucus discharge, > lens movement, blurred vision, discomfort
Management for CLAPC
Cease cl wear
Reduce wear time
Reevaluate px hygiene methods
Topical mast cell stabiliser (sodium cromoglicate 2% 1-2drops qds)
Combined antihistamine/mast cell stabiliser (olapatidine 0.1% 1drop 2/day)
What is dry eye and its signs and symptoms and treatment
Unstable tear film ,
Signs reduced tear miniscus and TBUT, conj hyperaemia, staining,
Symptoms irritation, stinging, blurred vision, grittiness
Tx - address environmental factors and screen time, ocular lubricants
What are the 4 main types of microbial keratitis
Bacterial keratitis (fluoroquinolones)
Fungal keratitis (anti fungal-natamycin)
Viral keratitis (HSV) (acyclovir - antiviral)
Acanthamoeba keratitis (tx is PHMB - antiprotazoal)
What is gram -ve vs gram +ve bacteria and examples
Gram -ve is usually CL related (pseudomonas/haemophilus) are harder to treat and require stronger agents like fluoroquinolones(ciproflocaxin/levofloxacin) or aminoglycosides(tobramycin)
Gram +ve (staphy/strep) are easier to treat with antibiotics like fluoroquinolones / CPL
Bacterial keratitis clinical signs and symptoms
Signs - ulcer with well defined border, hypopyon, epithelial defects and stromal infiltrates
Symptoms - sever pain, redness, mucus discharge
Fungal keratitis clinical signs and symptoms
Signs - branching/feathery white infiltrates parental, ring shaped stromal infiltrate, irregular epithelial defect
Symptoms - pain, moderate redness, less purulent/watery discharge
HSK clinical signs and symptoms
Signs - dendritic ulcer, stromal edema, well defined epithelial defects, irregular raised corneal epithelium
Symptoms - pain, burning, grittiness, redness
Acanthameoba keratitis clinical signs and symptoms
Signs - ring shaped stromal infiltrates, multiple irregular epithelial defects,
Symptoms - severe pain and redness
How does CL adapt to tear film on insertion
Upon insertion tear film is distrupted, overtime tear film stabilised and lens becomes more comfortable.
Cornea adjusts to the slight decrease in O2 permeability caused by lens
Sensory adaptation ; eyes nerve endings detect CL as a FB and overtime sensory adaptation occurs
Visual adaptation; brain and visual system adjust to optical change
