5.2.1 CL

Question 1

What are causes of cl complications

Answer 1

o Sleepinginlenses.
o Notfollowingreplacementschedulei.e.,usingdailylensesforaweektosaveoncost.
o Notfollowingcleaninginstructions.
o However, there are also cases of where the lens itself causes harm to patients. Examples
include poor lens fitting, poor choice of material etc.

Question 2

What are signs if hypoxia

Answer 2

Chronic cornel oedema leading to…

Microcysts
Vacuoles
Mucin balls
Limbal hyperamia
Neovas

• Hazy, blurred vision. Stromal striae, folds, haze
• Changes in Rx - typically slight myopic shift
• Polymegathism

Question 3

What are microcysts

Answer 3

cysts with distinct margins within the epithelium and is made up of broken-down cellular debris.

• seen reverse illumination

Unless in large amounts asymptomatic no affect to vision

Low dk lense

Management higher dk lense, switch to dailies ; reduce wear time

Question 4

What are vacuoles

Answer 4

Similar in size to microcysts, also has distinct margins.
- Non-reversed illumination unlike microcysts.
- Occurs with hypoxia and oedema of the cornea.
- Same management as microcysts

Question 5

What is polymegathism

Answer 5

• The changes in the endothelium can be transient as well as permanent morphologic changes. - Hexagonal, varies in size within endothelial monolayer.

Question 6

LID WIPER EPITHELIOPATHY (LWE)

Answer 6

Cause - mechanical friction between the lid wiper portion between the inferior and superior lid palpebral conjunctiva and the anterior surface of the contact lens.
- If insufficient lubrication between these surfaces, the lid epithelium will be exposed

Management
temporarily discontinue wear,
artificial tears and encourage tissue healing with regular drops.
- contact lens with lower coefficient of friction to ensure more comfort and to reduce friction against upper lid

Eg acuvue oasis bioinfmity

Question 7

Answer 7

CLPU

extended/continuouswear.
Signs:2mm round,well-define peripheral focal infiltrate.
o Positive fluorescein staining(unlikeIKandCLARE).
o Non-sightthreatening/self-limiting.

o Management:
- Will resolve once patient stops wearing lenses.
Advice limited extended wear for 6months.
- However, due to being similar to MK – MUST refer as emergency.
- Hospital may recommend lubricating drops. Sometimes they may give non-
steroidal anti-inflammatory drugs (NSAIDs) to relieve symptoms.

Question 8

Answer 8

Sterile,inflammatoryconditionofthecornea.
o pain and redness occur from waking up with sleeping in
contact lenses.
o Occurs due to a reaction to the exotoxins or endotoxins from gram negative bacteria
which is made worse by sleeping in lenses.
o Symptoms:moderatepain,irritation,photophobia.
o Signs:lessthan1mminfiltrateinanteriorstroma,canhappeninthemidperipheraland
peripheral cornea.
No staining with fluorescein.
o Non-infectious.

o Management:
- Stopping lens wear
using artificial tears until signs and symptoms have resolved.
- Change type of lenses to daily lenses.
- Advice not to wear them at night anymore.

CLARE

Question 9

Answer 9

Inflammatoryconditionofthecornea,mainlywithsoftcontactlenses.
o Affected patients will be asymptomatic.
Can experience mild to moderate pain, if any
and can be bilateral or unilateral.
o Signs: less than 1mm infiltrate in anterior stroma, no epithelial defect
no staining with fluorescein.

o Associated with contact lens solution, tight fitting lenses and staphylococcal
hypersensitivity (where the lens can harbour gram postive organisms).
o Non-infectious.
o Management:stopwearinglenses
o If toxicity reaction to solution then would changing them on to peroxide
refit daily lenses to prevent use of solution altogether.
o If tight fitting- refitwithlooserlenses

Infiltrative keratitis