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CL (Solutions) Flashcards

1
Q

CL Care: Why?

A
  • Minimize infections & other ocular complications (Giant Papillary Conjunctivitis, Superior Limbic Keratoconjunctivitis, Sensitivity reactions, Corneal infiltrates & ulcers)
  • Maintain good comfort & vision
  • Maintain diagnostic lenses
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2
Q

What are infections ocular complications

A
  • Giant papillary conjunctivitis
  • Superior Limbic Keratoconjunctivitis
  • Sensitivity reactions
  • Corneal infiltrates & ulcers
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3
Q

All CL care products, including solutions, disinfection units, & CL cases are required to undergo review by _________ before they can be sold to the public

A

Food & Drug Administration (FDA)

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4
Q

Solution undergo testing in following areas

A

Chemistry
Microbiology
Toxicity
Clinical evaluation

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5
Q

Chemistry: Solution stability

A
  • pH, salinity, viscosity, etc
  • Breakdown of chemical components
  • Sterility
  • Shelf life
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6
Q

Chemistry: Interaction with CL materials

A
  • Affect lens parameters
  • Discoloration
  • Absorption
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7
Q

kills rates for bacteria & fungi

A

Microbiology

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8
Q

kill organisms by simply placing the lens in solution

A

Disinfecting solutions

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9
Q

require a regimen including cleaning & rinsing to kill sufficient organism

A

Disinfection systems

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10
Q

Disinfecting solutions must be effective against what bacteria

A
  • Pseudomonas aeruginosa
  • Staphylococcus areus
  • Serratia macescens
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11
Q

Disinfecting solutions must be effective against what fungi

A
  • Candida albicans
  • Fusarium solani
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12
Q

Reduction of inoculum of bacteria

A

At least 3.0 log units within recommended disinfection time

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13
Q

Reduction of inoculum of fungi

A
  • At least 1.0 log unit within recommended disinfection time
  • No increase at 4 times the minimum recommended disinfection time
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14
Q

Disinfection system must have the following efficacy

A
  • Reduction in all bacteria by at least 5 log units
  • Reduction of each bacteria species by at least 1 log unit
  • Hold fungi at stasis level throughout recommended disinfection period
  • After putting inoculated lenses through the recommended disinfection regimen, the lens should not grow more than 10 colonies microogranisms on laboratory plates
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15
Q

Disinfection systems: Microbial growth rates during solution storage

A
  • Reduction of inoculated bacteria by 3 log units at 14 days, and of rechallenge by 3 long units at 28 days
  • Maintain molds & yeasts at initial levels throughout storage time
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16
Q

interaction with living tissues (Animals, In vitro), human testing

A

Toxicity

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17
Q

clinical research trial using groups of real patients

A

Clinical evaluation

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18
Q

at least 60 subjects for 3 months for new products

A

Clinical evaluation

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19
Q

at least 30 subjects for 1 month for roughly equivalent products

A

Clinical evaluation

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20
Q

FDA Approval

A
  • Product
  • Marketing claims
  • Labeling
  • Advertising
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21
Q

Components of Lens Care

A
  • Hand washing
  • Cleaning
  • Disinfection
  • Conditioning
  • Rewetting
  • Protein removal
  • Lens case care
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22
Q

best way to prevent spread of infectious diseases

A

Wash hands

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23
Q

before and after handling lenses & examining px

A

Wash hands

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24
Q

most bacterial contamination of lenses is from the _____

A

hands

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25
Q

Wash hands: With soap

A
  • Special soaps formulated for CL wearers
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26
Q

digital rub removes microogranims, proteins, oils, debris on the lens

A

Cleaning

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27
Q

Use of surfactant, solvent, and abrasive cleaners

A

Cleaning

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28
Q

Cleaning: ______ is an important step - removes up to 90% of surface debris

A

Rinsing

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29
Q

Cleaning: Even “_____” solutions require rinsing

A

“No-rub”

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30
Q

Reduction of microogranisms as described above

A

Disinfection

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31
Q

Disinfection: _______ is the time required to kill 90% of an organism

A

D-value

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32
Q

reduces risk of ocular infections

A

Disinfection

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33
Q

not the same as sterilization

A

Disinfection

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34
Q

soaking solutions and some cleaners

A

Disinfection

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35
Q

RGP lens surface require ______ to maintain adequate tear layer

A

Conditioning

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36
Q

Wetting agents & viscosity agents

A

Conditioning

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37
Q

Usually performed by disinfecting solutions

A

Conditioning

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38
Q

In eye drops that hydrate soft lenses & recondition RGP lenses

A

Rewetting

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39
Q

help reduce dry eye symptoms

A

Rewetting

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40
Q

helps remove surface debris

A

Rewetting

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41
Q

_____ causes blurry vision, discomfort, ocular complications

A

Protein

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42
Q

All lenses still require periodic replacement

A

Protein removal

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43
Q

separate step or during disinfection

A

Protein removal

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44
Q

Enzymes, Ionic compunds

A

Protein removal

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45
Q

Lens case: Case is an often overlooked source of contamination called

A

Biofilms

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46
Q

Clean & rinse case after lens insertion

A

Lens case

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47
Q

______ is an often overlooked source of contamination

A

Case

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48
Q

Allow case to air dry each day

A

Lens case

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49
Q

Lens case: replace case every _____months

A

3-6 months

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50
Q

What are the Solution Properties (POV)

A
  • Osmolarity
  • pH (Hydrogen ion concentration)
  • Viscosity
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51
Q

Tonicity of the team film = 0.9% NaCl equivalent

A

Osmolarity

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52
Q

Osmolarity: Tonicity of tear film

A

0.9% NaCl equivalent

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53
Q

Solution must be within a range of 0.7 to 2.0% to prevent stinging

A

Osmolarity

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54
Q

Osmolarity: Solution must be within range of ______ to prevent stinging

A

0.7% to 2.0%

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55
Q

pH of tear film

A

7.4

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56
Q

Solution pH must be between

A

6.6 and 7.8

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57
Q

Solutions with pH outside this range will sting on instillation

A

pH (Hydrogen ion concentration

58
Q

______help to maintain pH

59
Q

Solution properties: Borates, phosphates, nitrates, bicarbonates, citrates

A

pH (Hydrogen ion concentration)

60
Q

thickness of a solution

61
Q

Viscosity of Soft lens solutions:

A

low viscosity like saline solution

62
Q

Viscosity of RGP solution

A

can be higher viscosity to increasing wetting & cushioning

63
Q

Viscosity of rewetting agents

A

may be high viscosity

64
Q

Solution components

A
  • Preservatives
  • Benzalkonium Chloride (BAK)
  • Thimerosal
  • Chlorhexidine Gluconate
  • Sorbic Acid
  • Polyquarternium-1 (Polyquad)
  • Polyaminopropyl Viguanide (Drymed), Polyhexadine Hydrochloride (PHMB), Polyhexamethylene Biguanide (TrisChem)
  • Myristamidopropyl Dimethylamine (Aldox)
  • Ethylene Diamine Tetraacetic Acid (EDTA)
  • Benzyl Alcohol
65
Q

inhibit growth of microorganisms & keep solution bottles free from contaminants

A

Preservatives

66
Q

also serves as CL disinfectant, present in cleaners, rinsers, & disinfectants

A

Preservatives

67
Q
  • quaternary ammonium
  • antifungal & antibacterial
  • bacteriocidal in combination w EDTA
A

Benzalkonium Chloride(BAK)

68
Q

causes corneal SPK, conjunctival hyperemia & edema

A

Benzalkonium Chloride (BAK)

69
Q

binding to the lens matrix can lead to toxic concentrations in the tears

A

Benzalkonium chloride (BAK)

70
Q
  • not used in soft lens solutions, do not use eye washes to soak or rinse soft lenses
  • found in many ophthalmic drops
A

Benzalkonium chloride (BAK)

71
Q
  • organic mercurial
  • bacteriostatic (slow acting)
  • hypersensitivity reactions are common
A

Thimerosal

72
Q

causes SPK, conjunctival hyperemia, irritation

A

Thimerosal

73
Q

turns lenses grey

A

Thimerosal

74
Q

still used in cheap saline solutions

A

Thimerosal

75
Q

Biguamide antiseptic
Bactericidal
Disrupts bacteria cell membranes

A

Chlorhexidine gluconate

76
Q

Toxic reaction similar to Thimerosal in soft lens wearers

A

Chlorhexidine gluconate

77
Q
  • binds to soft lenses
  • turns lenses green
  • used extensively in RGP solutions
A

Chlorhexidine gluconate

78
Q
  • Bacteriostatic
  • Lower incidence of adverse reactions: low grade stinging
A

Sorbic acid

79
Q
  • Turns lenses yellow-brown
  • Original “sensitive eyes” preservatives
A

Sorbic acid

80
Q
  • quaternary ammonium compound
  • bactericidal
  • large molecular weight
A

Polyquaternium-1 (Polyquad)

81
Q
  • not absorbed into SCL as much as others
  • induces minimal tissue response
  • higher incidence of subepithelial infiltrates
A

Polyquaternium-1 (Polyquad)

82
Q

less likely to cause discoloration

A

Polyquaternium-1 (Polyquad)

83
Q

derivatives of Chlorhexidine but more effective

A

Polyaminopropyl Biguadine (Dymed), Polyhexadine Hydrochloride (PHMB), Polyhexamethylene Biguadine (TrisChem)

84
Q
  • large molecules
  • not absorbed into SCL as much as others
  • induces minimal tissue response in low concentrations
  • higher incidence of SPK
A

Polyaminopropyl Biguadine (Dymed), Polyhexadine Hydrochloride (PHMB), Polyhexamethylene Biguadine (TrisChem)

85
Q
  • anti-fungal & bacteria
  • kills bacteria, fungi, and Acanthamoeba trophs & cysts
A

Myristamidopropyl Dimethylamine (Aldox)

86
Q

penetrates cell walls, disrupts cell walls to cause cell death

A

Myristamidopropyl Dimethylamine (Aldox)

87
Q
  • indirect bacteriostatic agent
  • chelates calcium
  • ineffective when used alone
A

Ethylene Diamine Tetraacetic Acid (EDTA)

88
Q
  • calcium competes with preservative molecules for the active sites on the bacterial cell walls
A

Ethylene Diamine Tetraacetic Acid (EDTA)

89
Q
  • enhances efficacy of other preservatives, such as BAK
A

Ethylene Diamine Tetraacetic Acid (EDTA)

90
Q
  • bactericidal
  • used in RGP solutions
  • works well against biofilms, only when combined with a Surfactant
A

Benzyl Alcohol

91
Q

Cleaning Agents (SASO)

A
  • Surfactant
  • Abrasives
  • Solvents
  • Oxidants
92
Q

Cleaning agent: amphipathic compound (hydrophilic head, hydrophobic tail)

A

Surfactants

93
Q

Cleaning agent:
- like soaps
- reduce surface tension of fluids
- facilitate removal of debris, especially lipoidal deposits

A

Surfactant

94
Q

Cleaning agent: mostly nonionic bc few problems with toxicity
- Poloxamine, Poloxamer, Pluronic, Tetronic

A

Surfactants

95
Q

Cleaning agent: polymer beads/other solid particles

A

Abrasive Elements

96
Q

Cleaning agent: mechanically removes surface deposits, including bound protein films

A

Abrasive Elements

97
Q

Cleaning agent: found in soft & rigid cleaners
- Suspension - must shake well

A

Abrasive Elements

98
Q

Cleaning agent: solvent, capable of dissolving lipid deposits

A

Isopropyl Alcohol

99
Q

Cleaning agent: hydrogen peroxide
- Slight cleaning action - primarily a disinfectant

100
Q

increase surface wetting for better comfort, deposit resistance, and cleaning efficacy

A

Wetting Agents

101
Q

What are Wetting Agents

A
  • Polyvinyl alcohol
  • Polyvinyl pyrrolidone
  • Polysorbate 80
  • Povidone
  • Polyethylene glycol
102
Q

increase contact time for greater wetting, disinfection efficacy

A

Viscosity Agents

103
Q

Viscosity Agents: Cellulose derivatives

A

Hydroxypropylmethyl cellulose

104
Q

remove surface bound denatured protein (lysozyme) deposits

A

Protein removers

105
Q
  • used with lenses replaced less often than once a month
  • maintain clear, comfortable vision
A

Protein Removers

106
Q
  • enzymes cut proteins into small pieces
  • available in tablet or liquid forms
A

Enzymatic Cleaners

107
Q

dissolved in saline solution as a separate cleaning step or in disinfecting solution in a single step

A

Enzymatic Cleaners

108
Q

Enzymatic Cleaners: Rinsing removes protein fragments

A
  • Papain - derived from papaya
  • Pancreatin - derived from hog pancreas
  • Subtilisin - synthetic
109
Q

Cleaning agent: - buffer in Alcon solutions
- negative charged

110
Q

ionically binds to charged protein molecules & pulls them away from lens surface

111
Q
  • negatively charged two prolonged molecule
  • found in ReNu Multi-Plus multipurpose solution (B&L)
A

Hydranate (Hydroxyalkyl phosphonate)

112
Q
  • competes with calcium ions that bond protein molecules together to disrupt protein films
  • ionicallly carries protein molecules away from lens surface
A

Hydranate (Hydroxyalkyl phosphonate)

113
Q

Allergan Complete uses the high ionic strength of potassium to ionically remove lysozyme from the lens surface

114
Q

Solution types

A
  • Saline solution
  • Disinfecting solution
  • Multi-purpose solutions
  • Conditioning solutions
  • Daily cleaners
  • Rewetting solutions
115
Q

Types of Saline Solution

A
  • Unpreserved Saline Solution
  • Preserved Saline Solution
116
Q

Saline solution: salt tablets mixxed with distilled water, no longer FDA approved

A

Unpreserved Saline Solution

117
Q

Saline Solution: packages/bottles,
- Unisol: single use vials
- Unisol 4: 4 oz. bottle good for 14 days after opening
- Aerosol cans
- one way valve prevents contamination

A

Unpreserved Saline Solution

118
Q

Saline Solution: preservatives included to maintain solution disinfection

A

Preserved Saline Solution

119
Q

Saline Solution: shelf life once opened may be less than expiration date indicates
- important to examine expiration dates

A

Preserved Saline Solutions

120
Q

Solution type: decrease bacterial & fungal load on lenses as described above

A

Disinfecting solution

121
Q

Types of Disinfecting solutions

A
  • Chemical
  • Hydrogen peroxide
122
Q

Disinfecting solutions: preserved solutions that are able to attain the disinfection efficacy defined by FDA for disinfecting solutions (not disinfection system)

123
Q

Disinfecting solutions: lenses must be stored in the solution for a minimum soak time (typically 4-6 hours) Solutions have maximum storage time (up to 30 days)

124
Q

Disinfecting solutions: some must be neutralized or rinsed away prior to lens insertion

125
Q

Disinfecting solutions: most current disinfecting solutions can be used in the eye

126
Q

Disinfecting solutions: oxidative solution that kills microorganisms, including bacteria, fungi & protozoa

A

Hydrogen peroxide

127
Q

Disinfecting solutions: lenses must be soaked in solution for a minimum of 10 - 15 mins for maximum efficacy

A

Hydrogen peroxide

128
Q

Disinfecting solutions: H2O2 must be neutralized before lenses are inserted

A

Hydrogen peroxide

129
Q

Disinfecting solutions: H2O2 is neutralized to water & oxygen

A

Hydrogen peroxide

130
Q

soft & rigid lens solution containing all necessary components for cleaning, disinfection & wetting

A

Multi-purpose (MPS)

131
Q
  • preservatives for disinfection
  • Surfactants or other cleaners for cleaning efficacy
  • wetting agents
A

Multi-purpose Solutions (MPS)

132
Q
  • safe to use in the eye
  • may not require digital rubbing to attain sufficient cleaning efficacy
  • not necessarily stand-alone disinfecting solution
A

Multi-purpose Solutions (MPS)

133
Q
  • rigid lens solutions containing
  • preservatives for disinfection
  • safe to use in the eye
A

Conditioning Solutions

134
Q
  • wetting agents to temporarily make the hydrophobic surfaces wettable
  • usually need separate daily cleaner
A

Conditioning Solutions

135
Q

solutions that facilitate removal of loose surface debris

A

Daily Cleaners

136
Q

Daily cleaners removes these

A
  • Microorganisms
  • Protein
  • Lipids
  • Mucous
  • Dirt & other environmental debris
137
Q

contain surfactants, abrasive compounds, isopropyl alcohol, benzyl alcohol, other cleaning agents

A

Daily cleaners

138
Q
  • toxic to the eye
  • must be rinsed prior to lens insertion
  • usually performed after lens removal & before soaking
A

Daily cleaners

139
Q

solutions that are used in the eye during lens wear to increase comfort

A

Rewetting Solutions/Drops

140
Q
  • rehydrate soft lenses
  • flush debris
  • contain wetting & viscosity agents
A

Rewetting Solutions/Drops

141
Q
  • may contain cleaning agents to help keep lenses cleaner while on the eye
  • may not be packaged in bottles larger than 30 ml (sterility & handling)
A

Rewetting Solutions/Drops

P3 (11 decks)

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