CL related pathologies 1 Flashcards
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
What is (Asymptomatic) Infiltrative keratitis?
What are the clinical signs of AIK?
Why do the signs occur?
What are the symptoms of AIK?
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]
Can AIK (Asymptomatic Infiltrative Keratitis) progress?
No as it is not an infection , it is simply an inflammation
What is the managment for AIK (Asymptomatic Infiltrative Keratitis)?
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
What is a superior epithelial arcuate lesion (SEAL) and why may it occur with CL use?
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
What are symptoms associated with SEAL?
-Usually unilateral, asymmetric or, mildly symptomatic (these include irritation or foreign body sensation)
What is the management for SEAL?
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
What does CLPC stand for?
Contact lens Associated Papillary sonjunctivitis
What is CLPC and why does it occur?
It is a Conjunctival inflammation
Immunological response due to hypersensitivity to lens deposits or solution or mechanical response due to lens design or modulus.
How does Contact Lens Papillary Conjunctivitis typicaly present in soft contact lens wearers?
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).
How does Contact Lens Papillary Conjunctivitis typicaly present in RGP lens wearers?
In RGP lens wearers papilli tend to be flatter and located closer to the lash margin
True or False - Fluorescein can make it easier to appreciate papilli
True
Very early on CLPC looks very ‘normal’ - what is the differentiating factor?
In early CLPC (grade 2 or below) the inside of the upper eyelid looks excessively red
What are signs and symptoms associated with severe (grade 3 and above) Contact Lens Papillary Conjunctivitis?
Conjunctival Oedema
Excessive mucus
Mild Ptosis
Cornea may show punctate staining
Superior Infiltrates
Limbal injection may also be seen
In early CLPC what symptoms may a px complain of?
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]
Which conditions make someone more succeptible to CLPC?
MGD - Meibomian Gland Dysfunction
Any Atopic condition
What is the prognosis of CLPC?
In mild to moderate cases prognosis is good.
What is the management for CLPC if grade 2 or lower?
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)
What is the management for CLPC if above grade 2?
- 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
What does CLARE stand for?
Contact lens Acute Red Eye
What is CLARE and why does it occur?
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]
What is CLARE also referred to as?
Acute red eye or even tight lens syndrome
What effect does a tight lens have on CLARE (Contact Lens Acute Red Eye)?
It worsens in a tight lens environment - as essentially a tight lens means less tear exchange ( as well as dehydration and possible hypoxia).
What symptoms is CLARE (Contact Lens Acute Red Eye) characterised by?
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.
