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Introduction to Eye Disease - Year 2 > CL related pathologies 1 > Flashcards

CL related pathologies 1 Flashcards

1
Q

Group the following diseases based on their severity- from least, middle and most symptomatic:

  • (A)IK – asymptomatic infiltrative keratitis
  • SEAL – superior epithelial arcuate lesion
  • CLPC – contact lens associated papillary conjunctivitis
  • CLARE – contact lens acute red eye
  • CLPU – contact lens peripheral ulcer
  • MK – microbial keratitis
A
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2
Q

What is (Asymptomatic) Infiltrative keratitis?

What are the clinical signs of AIK?

Why do the signs occur?

What are the symptoms of AIK?

A

A condition in which there are sterile corneal inflitrates

These are seen as wite spots in the cornea. [Can see this in picture]

The infiltrates/white spots are inflammatory cells from limbal blood vessels - they occur in response to hypoxia, bacteria, lens deposits, allergic reaction, poor hygiene etc.

  • Eye moderately red and slightly watery, Mild foreign body sensation , Mild photophobia

[Severity of cases ranges- can be asymptomatic]

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3
Q

Can AIK (Asymptomatic Infiltrative Keratitis) progress?

A

No as it is not an infection , it is simply an inflammation

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4
Q

What is the managment for AIK (Asymptomatic Infiltrative Keratitis)?

A

Temporary discontinuation of CLs

  • most signs and symptoms resolve within 48 hours (so ideally you want to see px in two days to confirm this)
  • infiltrates resolve over 2-3 weeks
  • Advice against EW (Extended Wear)

If reoccurrant, switch to DD (daily disposable)

  • Careful monitoring
  • Ocular lubricants and cold compresses for symptomatic relief
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5
Q

What is a superior epithelial arcuate lesion (SEAL) and why may it occur with CL use?

A

Arcuate staining parallel to superior limbus - you want to check under top lid to make sure you don’t miss it.

It can be due to mechanical pressure as a result of the design or material of the lens

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6
Q

What are symptoms associated with SEAL?

A

-Usually unilateral, asymmetric or, mildly symptomatic (these include irritation or foreign body sensation)

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7
Q

What is the management for SEAL?

A

Cease CL wear for 1-7 days (depends on severity)

Issue lubricants

Review lens fit or material

Use thinner, more flexible lens material

Change back-surface geometry of the CL

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8
Q

What does CLPC stand for?

A

Contact lens Associated Papillary sonjunctivitis

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9
Q

What is CLPC and why does it occur?

A

It is a Conjunctival inflammation

Immunological response due to hypersensitivity to lens deposits or solution or mechanical response due to lens design or modulus.

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10
Q

How does Contact Lens Papillary Conjunctivitis typicaly present in soft contact lens wearers?

A

In SCL wearers papilli tend to be located at the tarsal plate - so closest to the fold when you invert the eyelid. They also tend to progress to become rather round and large (exceeding one millimetre).

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11
Q

How does Contact Lens Papillary Conjunctivitis typicaly present in RGP lens wearers?

A

In RGP lens wearers papilli tend to be flatter and located closer to the lash margin

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12
Q

True or False - Fluorescein can make it easier to appreciate papilli

A

True

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13
Q

Very early on CLPC looks very ‘normal’ - what is the differentiating factor?

A

In early CLPC (grade 2 or below) the inside of the upper eyelid looks excessively red

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14
Q

What are signs and symptoms associated with severe (grade 3 and above) Contact Lens Papillary Conjunctivitis?

A

Conjunctival Oedema

Excessive mucus

Mild Ptosis

Cornea may show punctate staining

Superior Infiltrates

Limbal injection may also be seen

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15
Q

In early CLPC what symptoms may a px complain of?

A

Discomfort and even itchiness towards the end of the wearing period.

(Maybe mucus deposits)

Intermittent blurring

[Essentially these sy,ptoms are caused by the lens getting stuck to the papilli]

[As severity of CLPC increases symotims do too]

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16
Q

Which conditions make someone more succeptible to CLPC?

A

MGD - Meibomian Gland Dysfunction

Any Atopic condition

17
Q

What is the prognosis of CLPC?

A

In mild to moderate cases prognosis is good.

18
Q

What is the management for CLPC if grade 2 or lower?

A

Manage if grade >2 (no need for any referal or drugs)

Lens wear can continue if symptoms permit

Advice px on Improving lens hygiene (cleaning and wearing time modality)

19
Q

What is the management for CLPC if above grade 2?

A
  • Altering the lens material
  • Replacing lenses more frequently
  • Altering or eliminating the care system
  • Treating any associated meibomian gland dysfunction
  • Prescribing pharmaceutical agents
  • Dispensing ocular lubricants for symptomatic relief
  • Reducing wearing time
  • Suspending or ceasing lens wear
20
Q

What does CLARE stand for?

A

Contact lens Acute Red Eye

21
Q

What is CLARE and why does it occur?

A

It is an Inflammatory response of the cornea and conjunctiva subsequent to a period of eye closure with CL wear - i.e. it is associated with overnight lens wear

Most common cause is due to endotoxins from gram negative bacteria (especially Pseudomonas spp)

[Basicallly bacteria accumulates on lens from poor cleaning and then the px wears the lens overnight]

22
Q

What is CLARE also referred to as?

A

Acute red eye or even tight lens syndrome

23
Q

What effect does a tight lens have on CLARE (Contact Lens Acute Red Eye)?

A

It worsens in a tight lens environment - as essentially a tight lens means less tear exchange ( as well as dehydration and possible hypoxia).

24
Q

What symptoms is CLARE (Contact Lens Acute Red Eye) characterised by?

A

A sudden unilateral onset of pain, epihphora and ocular irritation.

Pxs wull often say they woke up in the middle of the night with a painful red eye.

25
Q

What are signs of CLARE (Contact Lens Acute Red Eye)?

A
  • Unilateral
  • Acute hyperaemia - diffuse conjunctival and limbal
  • Diffuse infiltrate keratitis,
  • Possibly anterior chamber reaction.
  • Epithelial and sub-epihtleial infiltrates -generally located in corneal periphery and mid periphery.
26
Q

How do you differentiate CLARE from microial keratitis?

A

Instill fluorescein - infiltrated areas should not exhibit overlying punctate staining- indicating minimal epithelial involvement .

[If it does refer ion suspicion of Microbial Keratitis]

27
Q

In severe cases of CLARE what may be present?

A

Corneal oedema

Anterior Uvietis may be present although this is rare- this is where you may possibly have an anterior chambre reaction.

28
Q

Is VA affected in CLARE/

A

In CLARE VA is usually unaffected

29
Q

Why is it sensible to ask any px presenting with a possibility of CLARE about common cough cold flu symptoms such as headache, fatigue, etc?

A

A risk factor for CLARE is common respiratory tract infections - these are associated with the gram nergative bacteria which is a common cause of CLARE

30
Q

Excluding common respiratory tract infections, what are risk factors of CLARE?

A

High water content CLs

Tightly fitted lenses

31
Q

What is the management of CLARE?

A

It is self limiting so we conservatively manage - it can take days tp weeks to resolve, infiltrates will take longer (months).

In any case we ask px not to wear CL when ill.

We educate px on cleaning CLs effectively.

We may prescribe artificial tears for comfort

Prescribe Silicone Hydrogels at all times

Shorter intervals between CL appts

32
Q

Why do we recommend shorter intervals between CL appts for px who have had CLARE?

A

There is a 50-70% chnace of a recurrent episode thus shorter intervals are recommended to pick up on the condition.

33
Q

Which clinical fetaures do px who have had CLARE retain?

A

Px who have had CLARE tend to retian higher levels of limbal injection, bulbar injection and conjunctival staining afterwards when compared to controls (i.e. pxs who have never had CLARE).

34
Q

Generally speaking what is the advice on CL wear when a px is ill?

A

We advise pxs not to wear contact lenses when ill

35
Q

Generally speaking what is the advise regarding contact lenses being uncomfrtable or painful?

A

We advise px to cease contact wear until we can find out what is causing the problem

36
Q

Generally speaking for px with highly recurrable conditions what must we as an optometrist make sure?

A

That we are easy to contact in the case of an emergency or a recurrent episode

Introduction to Eye Disease - Year 2 (40 decks)

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