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CL 2 > Complications 1+2 > Flashcards

Complications 1+2 Flashcards

1
Q

Name 5 effects of CL wear on the anterior seg (7 possible):

A
  • hypoxia
  • desiccation
  • debris entrapment
  • microbial attachment
  • mechanical effects
  • surface deposits
  • solution sensitivities
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2
Q

major effect of hypoxia on the cornea:

-other significant effects?

A

hypoxia causes corneal EDEMA
-others: increased BACTERIAL ADHERENCE, debris accumulation (microcysts), increased acidity (lactate accumulation), decreased healing and corneal sensitivity

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3
Q

What molecule is needed by the cornea to PREVENT swelling?

-how much does it swell overnight w/ nml lid closure?

A

oxygen

2-4% (not enough to cause clouding/epi swelling)

13% O2 to maintain nml mitosis
8% to prevent decreased corneal sensitivity

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4
Q

Use of WHICH lens type (broad category) with WHICH solution does NOT result in increased bacterial binding over 1 year?

A

SiHy lenses with UNpreserved solution; OR CLEARCARE soln

-use of any other lens type w/ PRESERVED soln resulted in increased bacterial binding

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5
Q

Define: COR (Critical Oxygen Requirement)

A

minimum Dk/t level required to prevent measurable corneal changes - different for DW and EW

i.e., for NO additional corneal swelling; DW = 23, overnight = 87

Mertz study also says a minimum 10% oxygen is needed to prevent swelling

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6
Q

Most common reason why pts drop out of CL wear?

A

dry eye/desiccation

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7
Q

Which bacteria are most common in normal cases of microbial keratitis? How about in CL-induced MK?

A

nml - staphlococcus

CL-induced - pseudomonas

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8
Q

What does an infiltrate with feathery borders and satellite lesions most likely indicate regarding its origin?

Most COMMON type of this organism?

A

it’s probably FUNGAL - ABx won’t work.

Fusarium. Also, could be candida, aspergillus, cephalosporin

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9
Q

Which type of microbe will cause pain out of proportion to the corneal findings, pseudodendrites, and a late ring infiltrate (and may originate from a water source)?

A

Acanthamoeba

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10
Q

What type of reaction do solutions yield in solution sensitivity CL reactions?

A

Type 4 hypersensitivity - to thimerosal, polyquad, etc. Certain combos of Sihy lens and soln may result in this more frequently

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11
Q

CC: vision is blurry/cloudy AFTER LENS REMOVAL. Doctor finds temporary shift toward MINUS power - what condition is this?

  • also: distorted Ks, poor acuity endpt
  • Tx?
A

epithelial edema

Tx: D/C lens wear, switch to higher Dk

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12
Q

CC: “mild haze/haloes” - but none rly.
Sx: DESCEMET’S STRIAE, FOLDS, CENTRAL HAZE (>18%)

A

stromal edema

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13
Q

Difference between microcysts and vacuoles?

  • what do they indicate?
  • note: both start @ basal cells initially
A

Microcysts: contain CELLULAR DEBRIS. Viewable with REVERSED illum.
Vacuoles: FLUID-FILLED. Viewable with UNREVERSED illum.
-both will cause SPK once they reach the surface
-both are 2’ CHRONIC HYPOXIA

Tx: D/C lenses if >50 present, will go away w/i several weeks

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14
Q

What percent oxygen is required to:

  • prevent changes in epithelial mitosis and lactate accumulation?
  • prevent decreased corneal sensitivity?
A

13% (lactate)

8% (sensitivity)

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15
Q

Non-compliance rate vs manufacturer recommendations? Vs doctor recommendations?

A

manufacturer - 67%
doctor - 60%

2-week replacement: 82!!!
1-month: 53%

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16
Q

Most common grading of NEOVASCULARIZATION? What are the other gradings?

Tx?

A

Grade 1: 2.5 (or any ONE w/i 3mm of corneal apex)

If grade 4: refit to Sihy…WATCH ALL STAGES for GHOST vessels

17
Q

Polymegethism: change in ___
Pleomorphism: change in ___
-both are caused by what?
-Tx?

A

mega: size
morph: shape
HYPOXIA to ENDOthelial cells
Tx: change to Sihy or GP

18
Q

CC: severe spectacle blur and PAIN x2-3 hrs after lens removal, lens intolerance, central SPK/clouding

  • what condition is this? Hint: it’s secondary to increased PLIABILITY (2’ to increased edema)
  • Tx?
A

SLACH - SL-Associated Chronic Hypoxia
-aka OVERWEAR SYNDROME

-Tx: D/C lens wear, Rx ATs, prophylactic ABx if necessary, or bandage CL (low water)

19
Q

name the changes to each layer of the tear film w/ SCL and GP lenses
-lipid, aqueous, mucoid

A

lipid: thin or NONE
aqueous: present on SCL, dries quickly on GP
mucoid: loose attachment over SCL, NONE on GP

20
Q

Pt presents w/ nonspecific complaints of CL dryness. Doctor notes a HIGH water content lens being used, and INFERIOR CENTRAL ARCUATE** staining
-what’s the diagnosis?

A

soft lens dessication

21
Q

What’s the condition similar in appearance/complaint to soft lens desiccation, in GP LENSES?
-Tx?

A

Peripheral 3+9 staining (peripheral corneal desiccation)

Tx: refit the GP lens

22
Q 
CC: dry, gritty, decreased WT, REDNESS.
Signs: (+)INFILTRATE w/ epi defect and accommpanying neo, (+)bulbar injection, (+)3+9 staining
-what's the diagnosis?
-cause?
-Tx?
A

VLK - vascularized limbal keratitis

  • cause: CHRONIC hypoxia (eventual epi/stromal hypertrophy allowing effects)
  • Tx: D/C lens, TOPICAL ABx, STEROID to prevent scarring (infiltrate)
23
Q

CC: dry, gritty, decreased WT, REDNESS.
Signs: **peripheral corneal desiccation w/ adjacent conj elevation. Also, excavation @ 3+9 and poor lens mvmt.
-Tx?

A

Dellen

Tx: D/C and focus on hydration therapy (ATs), Rx ABx if necessary

24
Q

Pt presents for CL eval. Notes reuse of lenses, poor care lately, mild/moderate irritation, redness, tearing (OR NONE).
Signs: small, single or multiple NON-STAINING infiltrates seen in anterior stroma w/ (+) conj injection.
-what’s the diagnosis?
-Tx?

A

Infiltrative Keratitis

  • cause: INFLAMMATORY; something on corneal surface (endotoxin, preservative).
  • Tx: modify lens habits
25
Q

Pt calls you first thing in the MORNING complaining of a PAINFUL, RED EYE. Woken up in the middle of the night by it. Redness, tearing, etc.
Signs: (+)trapped debris b/w lens and cornea, possible infiltrates.
-what’s the diagnosis? Type of bacteria involved?
-Tx?

A

CLARE - contact lens acute red eye
-inflammatory response 2’ to gram-NEGATIVE toxins**
Tx: prophylactic ABx (fluoroquinolone), steroid if NO staining present (ie you’re sure it’s not an ulcer)

26
Q

CC: mild irritation, itching, (+)FBS, bulbar redness
Signs: (+)SEI w/ overlying epi defect. (+)sectoral injection, (+)necrosis 2’ to immunological or microbial invasion, (+/-)AC rxn.
-what’s the diagnosis? Offending organism type?
-Tx?

A

CLPU - CL Peripheral Ulcer

  • Gram-POSITIVE (only one)(if microbial); began as an infiltrate and progressed.
  • Can be sterile or microbial
  • Tx: HARD ABx (fluoroquin) q1h x24h, then QID until resolution
  • steroid only AFTER epi has healed
27
Q

Pt calls w/ severe pain, redness, photophobia, discharge.
Signs: severe injection, corneal/lid edema, stromal/epi involvement, hypopyon, mucopurulent discharge.
-Offending organism?
-what’s the diagnosis?
-Tx?

A

MICROBIAL KERATITIS* - what you NEVER want.

  • pseudomonas (or serratia); Gram NEGATIVE
  • NOTE: STAPH is actually the MAIN cause of MK; pseudomonas causes
  • Tx: LOAD-DOSED** Q15-30 MINS x6 hrs, then q24h BIG FLUOROquin. Cyclo/RTC 24h
  • Note: acanthamoeba is the SECOND most common cause of MK in hong kong
28
Q

tendencies: STERILE VS MICROBIAL

A

STERILE: peripheral, small, local, mild/no pain, serous discharge, mild/no AC rxn
MICROBIAL: central, larger, diffuse, severe pain, mucopurulent discharge, (+)AC rxn

29
Q

Classic appearance of fungal infection? Most common fungal organism?

  • fungal keratitis: causes a ____ infiltrate @ late stage.
  • Tx?
A

infiltrate w/ FEATHERY borders

  • ACANTHAMOEBA, FUSARIUM
  • RING infiltrate**
  • Natamycin q30-60 mins
  • hospitalize if it’s acanthamoeba (causes pain OUT OF PROPORTION to clinical findings)
30
Q

CC: itchy, stringy discharge, lens intolerance.
Signs: LARGE PAPILLAE*
-which zones are the papillae in SCL and GP?
-what’s the diagnosis?
-Tx/STAGES?

A

CLPC (GPC)
zones 1-3 if SCL, zone 3 if GP
Tx: dependent on stage
1: D/C wear, refit
2: (enlarged papillae, milld blurry VA) - refit
3 (clover-like papillae): antihistamine, vasoconstrictor, NSAID, refit - NO ABx, this is INFLAMMATORY!!!
4: STEROID*, NSAID, MC stabilizer

31
Q

Pt calls complaining of burning, tearing, itching, and superior bulbar redness*

  • what’s the diagnosis?
  • cause??*
  • Tx?
A

Superior limbic keratoconjunctivitis

  • superior suggests HYPOXIA
  • hypoxia is 2’ to lens deposits of soln preservative, THIMEROSAL
  • Tx: D/C soln w/ thimerosal, Rx steroid
32
Q

If all you see is DIFFUSE bulbar injection/SPK, what’s the most likely diagnosis?

A

SICS - solution-induced corneal staining

Note: SEI are possible - if persistent x2 wks, Rx steroid qid x2 wks full course

33
Q

Difference between SLK and SLK of theodore?

A

SLK - anyone. FINE papillae

SLK of Theodore - middle-age females w/ thyroid problems. DENSE papillae

34
Q

Pt complains of acute, sharp pain after getting something in their eye.

  • what’s the diagnosis?
  • greater chance of infection by gram ____ bacteria
  • Tx? (esp for large abrasions?)
A

corneal abrasion/FB tracking

  • increased chance of gram NEGATIVE infection
  • if LARGE (>6mm) DO NOT PATCH. Instead, use BANDAGE CL w/ ABx (fluoro), NOT to be worn overnight - use ABx ointment qhs, RTC 24h
35
Q

Mucin balls** are seen in what condition?

  • indentations of what corneal layer? (d/t air bubbles)
  • how should you change the lens to reduce the ball count?
A

dimple veiling

  • epithelium
  • STEEPEN the lens (to decrease lens mvmt which is causing the balls), DECREASE the modulus
36
Q

Pt in for CL PE, notes very mild lens awareness.

  • doctor sees faint linear break/split toward superior cornea*, and notes the lens is fit tightly
  • what’s the diagnosis?
  • Tx?
A

SEAL: superior epithelial arcuate lesion

  • cause: high-modulus lens causing epithelial splitting
  • Tx: remove lens, refit to lower mod, lubricate
37
Q

T/F: GPs can cause a ptosis

A

True; 2’ to decreased lid sensitivity and possibly 2’ to tug-and-blink lens removal. (SCL won’t cause a ptosis)

CL 2 (10 decks)

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