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OD4: Optometry Internship and Graduate Y1: Specsavers > Clinic: CL complications and aftercare > Flashcards

Clinic: CL complications and aftercare Flashcards

1
Q

List 7 possible causes of CL discomfort

A 
CL properties
Patient factors (hygiene)
Medications
Compliance
Ocular surface condition
External environment
Occupational factors
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2
Q

List 6 management options for CL discomfort

A 
CL exchange
CL modality change (change wearing schedule)
Patient education (e.g. hygiene)
Lubrication
Tx of any ocular or systemic disease
Environment modification
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3
Q

List 6 risk factors for post CL corneal neovascularisation

A 
High myopia
High astigmatism
Improper contact
lens alignment
HSV
Post-keratoplasty
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4
Q

List 4 management options for CL corneal neovascularisation

A

CL exchange (re fit to higher dk/t lens if hydrogel EW)
CL modality change
Anti-angiogenic therapy
Laser photocoagulation

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5
Q

What are SEALs?

A

Superior Epithelial Arcuate Lesions - full thickness lesions with split/jagged edges appearing usually around 1mm from superior limbus

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6
Q

In what contact lens modality can SEALS typically occur? Why?

A

EW Si-Hy - usually due to stiff nature of Si-Hy material.

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7
Q

List 7 risk factors for SEALs

A 
CL properties
Male gender
Presbyopia
Tight upper lid
Steep cornea
Corneal abrasion
EW Si-Hy lenses
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8
Q

List 2 management options for SEALs

A

CL exchange

CL removal

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9
Q

What is CLPU?

A

Contact Lens Peripheral Ulcer - variant of infiltrative keratitis specifically associated with lens wear

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10
Q

Describe the clinical features of a CLPU

A

Circular, well-circumscribed focal infiltrate (anterior stroma) <2mm, involving loss of overlying epithelium

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11
Q

How likely are recurrences of CLPU?

A

likely

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12
Q

List 2 risk factors for CLPU

A

EW Si-Hy lenses

Corneal abrasion

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13
Q

List 2 management options for CLPU

A

Discontinuation of CL
Consider replacing EW CL with DD (daily disposable)
NSAIDs

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14
Q

List 4 risk factors for bacterial keratitis in CL wearers

A

Hypoxia
Microtrauma
Contamination (poor hygiene? etc)
Extended Wear

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15
Q

How do you manage CL associated bacterial keratitis? (3)

A

Empirical monotherapy with fluoroquinolones (e.g. ciprofloxacin)
CL removal
swab and culture

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16
Q

List 2 risk factors for Acanthamoeba in CL patients

A

Multi-purpose solution poor compliance

Tap water use

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17
Q

How do you manage CL associated acanthamoeba keratitis?

A

Initially treat as bacterial/normal CL keratitis
2 day review? (1-2 days if central) if no improvement:
Same day referral to opthalm/emergency centre
Telephone hospital to tell them what you have done

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18
Q

How do you manage HSV keratitis (5)

A

Acyclovir ung 5 x a day
Debridement and patching acyclovir also potential treatment
Do NOT use topical steroids in active HSV epithelial keratitis (However DO use it in stromal keratitis etc)
Manage IOP as needed
Comfort: (lubricants, cycloplegia)

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19
Q

Name one oral medication regime for HSV keratitis and HZV keratitis

A

HSV: Acylovir 400mg tablets 5/day for 1 week
HZV: Acylovir 800mg tablets 5/day for 1 week

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20
Q

Describe the clinical features of GPC

A

Hyperaemia and papillary reaction of upper tarsal conjunctiva in CL wearers

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21
Q

List 4 risk factors for GPC

A

Si-Hy lenses
EW lenses
Mechanical trauma
Allergy and atopy

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22
Q

List 3 management options for GPC (5)

A

Transient removal of CLs
CL exchange (once healed)
Consider changing modality to DDs
Topical AH/MCS: Patanol BiD or Zatiden BiD for several months
if that doesn’t work:
FML iBD-iQD in short term for more severe cases

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23
Q

List 4 risk factors for dry eye in CL patients

A

Hydrogel lens
Lower refractive index
Female
Increased daily wearing time

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24
Q

List 3 management options for dry eye in CL patients

A 
CL exchange (to Si-Hy lenses if not already. Or just exchange between current Si-Hys for another Si-Hy)
Lubricants/Artificial tears
25
Q

Define ptosis. Does it occur more often with RGPs or Soft CLs?

A

MRD1 =1.5mm. Occurs more often with RGPs.

26
Q

List 2 risk factors for ptosis in CL wearers

A

Age

Wearing time

27
Q

List 1 management option for ptosis in CL wearers

A

Surgical

28
Q

Describe the appearance of pingueculae

A

yellowish to brown nodules on the bulbar conjunctiva near the sclerocorneal junction

29
Q

Describe the incidence of pingueculae in CL wearers vs non-CL wearers

A

20-33% in CL wearers vs 13-14% in non-CL wearers.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423374/table/T1/?report=objectonly

30
Q

List 1 management option for pingueculae

A

Surgical

Or could just do nothing

31
Q

List 2 risk factors for corneal staining in CL patients on fluorescein testing

A

CL fit/properties

Increased daily wearing time

32
Q

List 3 management options for corneal staining in CL patients

A

CL exchange

Decrease wearing time

33
Q

Describe corneal edema

A

Corneal swelling that blurs vision

34
Q

List 2 risk factors for corneal edema in CL patients

A

EW schedule

Atopy (i.e. contact allergic related)

35
Q

List 2 risk factors for allergic response in CL patients

A

EW schedule

Atopy (i.e. contact allergic related)

36
Q

List 5 management options for allergic response in CL patients

A 
CL exchange (to DDs?)
Reduce wear time
Preservative-free lubricants
Allergen avoidance
AH/MCS (e.g. patanol BID for several months re GPC)

https://pubmed.ncbi.nlm.nih.gov/11057353/

37
Q

What are mucin balls?

A

pearly transparent, spherical particles which are actually accumulation of post-lens debris: shearing of tear film rolling of debris into balls

38
Q

What do mucin balls consist of? (2)

A

mucin and lipid

39
Q

List 2 risk factors for mucin balls in CL patients

A

EW schedule

Steeper corneas

40
Q

What happens to mucin balls on removal of the contact lens?

A

They are rapidly blinked away, however they leave behind depressions within the epithelium, which can be seen with SL/fluorescein

41
Q

How do we manage mucin balls in a CL patient?

A

There is no evidence currently that mucin balls are associated with long term deleterious effects, however you could consider a CL exchange for a better fit if needed

Particularly would go with CL exchange if large number of mucin balls is having any effect on vision

42
Q

How can you manage a herpes reactivation in a CL patient?

A

Mx as per herpes. And give patient a longer time on prophylactic treatment.

43
Q

List 9 components to a CL aftercare

A 
History
General observation
Vision (often both with and without CL)
Spherocyl over-rx (SCO)
Topography or keratometry over CL
Assess fit and condition of lenses
SL examination (with and without fluorescein)
Subjective refraction (not always required. Only done if not sure why reduced VA)
Management and advice
44
Q

What feature of CL symptoms/discomfort might indicate to you that you have a tight fitting lens?

A

Symptoms later in the day

45
Q

What should you consider in the history taking of a CL aftercare patient? (5)

A

Vision: quality + consistency and comfort
Redness, Dryness, Itching, Tearing, Pain, Discomfort, Discharge, Photophobia, etc
Usage: wear times, lens rep, mode of wear
Lens maintenance
Review medications and general health

46
Q

How does CLARE occur?

A

Contact lens-induced acute red eye (CLARE) occurs in the presence of corneal hypoxia combined with noninvasive gram-negative bacteria that elicit an inflammatory reaction secondary to bacterial endotoxin. No actual corneal infection exists in this case.

47
Q

List 5 management options for CLARE

A 
Discontinue CL wear
Comfort: lubricants, cycloplege
Steroids for severe symptoms and significant infiltration
Re-establish successful DW eventually
Recurrence possible
48
Q

What 9 aspects of CL discomfort should we investigate with the patient?

A 
Onset
Consistency
Laterality
Quality
Severity
Location
Comparison (with and without CLs)
Associations (pain, redness, photophobia, discharge, etc)
Behaviours (e.g. changed working environment, changed CL care system, different ocular lubricants, etc.)
49
Q

How should you discuss CL hygiene with a CL aftercare patient?

A

Get them to tell you how they do it.

50
Q

Describe the 5 steps of the CL surface cleaning procedure

A

Wash hands
Place lens in palm of hand
Place 2-3 drops of solution on each lens surface
Rub each side with forefinger for ~15 secs
Rinse well

51
Q

How often should the CL surface cleaning procedure be done?

A

Must be done every time lenses are removed and with all lenses to be used again

52
Q

With what kind of solution is CL surface cleaning typically conducted with?

A

Multi purpose solution (but there are daily cleaners as well)

53
Q

How long do manufacturers recommend disinfection with 3% H2O2 solution

A

6 hours (overnight)

54
Q

How long do biguanides (PAPB/PHMB) take to achieve disinfection of CLs?

A

4-6 hours (overnight)

55
Q

How long does polyquad take to achieve disinfection of CLs?

A

6 hours (overnight)

56
Q

What is the benefit of Multi-purpose solutions?

A

They combine the actions of cleaning, rinsing, disinfection, storage/soaking and sometimes enzyme cleaning

57
Q

List 4 Multi-purpose solutions for CLs

A

Opti-free
Complete
Renu
Bio true

58
Q

Ideally, how often should CL cases be replaced?

A

Every 3 months

59
Q

How often should CL cases be cleaned? How is this achieved

A

Daily: use disinfecting solution/hot water/toothbrush/cotton bud

Make sure you (air) dry them after

OD4: Optometry Internship and Graduate Y1: Specsavers (35 decks)

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