CLM - Preliminary Examination, Insertion, and Removal - Week 2

Question 1

Does having contact lenses exclude the need for spectacles?

Answer 1

No

Question 2

List 5 personal indications for contact lens wear.

Answer 2

Cosmetic reasons
Highly motivated patient
Sport
Occupation
Large refractive error

Question 3

List 8 personal contraindications for contact lens wear

Answer 3

Environment
Occupation
Low refractive error
Monocular wear
Poor hygiene
Poor manual dexterity
Sensitive eyes (fear of touching eyes)
Poor motivation

Question 4

List 7 ocular indications for contact lens wear.

Answer 4

High refractive error
Anisometropia
Aphakia
Trichiasis
Dry eye syndrome
Exposure keratitis
Nystagmus (children)

Question 5

List 7 ocular contraindications for contact lens wear. (“these are actually indications” - Bang)

Answer 5

Recurrent erosions
Bulbous keratopathy
Ocular dysfigurement
Unsuccessful refractive surgery
Post-keratoplasty
Keratoconus
Children (self esteem)

Question 6

List 11 cases where additional care would be required for contact lens wear.

Answer 6

Cosmetically noticeable strabismus
Conjunctivitis
Dry eye
Glaucoma
Kistory of keratitis
Ocular allergies/hayfever
Decreased corneal sensitivity
Pingueculae
Lid conditions (chalazions/hordeolum)
Pterygia
Uveitis

Question 7

How can general health affect contact lens wear?

Answer 7

Poor health can lead to poor tolerance

Question 8

How can smoking affect contact lens wear (2)?

Answer 8

Dry eye

Particulate matter

Question 9

How can chronic sinusitis affect contact lens wear (2)?

Answer 9

Increased mucus in tears

More lens deposits

Question 10

How can allergies affect contact lens wear (2)?

Answer 10

Increased risk of poor tolerance

Hypersensitivity to solutions/contact lens material

Question 11

List two skin problems that can be exacerbated with contact lens wear?

Answer 11

Acne rosacea and atopic eczema

Question 12

How can thyroid disease affect contact lens wear (4)?

Answer 12

Dry eye
Exophthalmos
Reduced blinking
Less tear flow

Question 13

How can pregnancy affect contact lens wear (2)?

Answer 13

Less stable tear film, increasing chance of intolerance

Question 14

List 6 issues associated with contact lens wear and diabetes.

Answer 14

Blepharitis
Dry eye
Epithelial fragility and reduced healing rate
Higher risk of pathogenic keratitis
Unstable refraction
Reduced corneal sensitivity

Question 15

True or false

Diabetic patients are generally able to be fit with extended wear contact lenses (sleeping lenses).

Answer 15

False

Question 16

List the 5 components of a preminary workup for contact lenses.

Answer 16

Complete history
Refraction
External eye examination
Slit lamp biomicroscopy
Keratomotry / topography

Question 17

List the 6 components of history taking for contact lens wear.

Answer 17

Motivation
Ocular history
Occupation
Systemic/allergic history
Medications
Intended wearing type

Question 18

What 5 external eye examination ocular parameters are measured?

Answer 18

Corneal diameter (HVID)
Pupil diameter (dim)
Palpebral aperture
Lids tight/flaccid - high/low
Corneal sensitivity

Question 19

What four things must be assessed during a slit lamp examination? What grading scale should be used, ideally? Is this done before or after contact lens fitting?

Answer 19

Thorough anterior eye examination
Lid eversion
Fluorescein staining
TBUT
Effron scale is ideal (otherwise mild, moderate, severe)
Must be done after contact lens fitting

Question 20

What do keratometry and topography provide an initial estimate of?

Answer 20

An appropriate contact lens base curve

Question 21

What can forcible compression of eyelids cause? Is this common or rare?

Answer 21

Oculocardiac reflex - triad of bradycardia, nausea, and faintness/unconsciousness
Very rare

Question 22

What can be done if a foreign body sensation is felt upon wearing a contact lens? Which type can this be done on?

Answer 22

Soft lenses only

Do a scleral swish