Conjunctiva and Limbus in CL wear Flashcards
What can cause bulbar conjunctiva and limbal hyperaemia?
Hypoxia
Hypercapnia
Acidic shift
Toxicity from drops or sols
Allergy
Inflammation
Infection
Mechanical aggravation/damage
Exposure (e.g. to AC)
What is hypercapnia?
Too much carbon dioxide
Why do soft lenses tend to lead to more redness than RGPs?
Soft lenses cross over the limbus and conjunctiva, so can cause more mechanical aggravation. RGPs don’t cross over the limbus.
At what stage does bulbar conjunctival hyperaemia need management?
If grade 2 or above
How do you manage bulbar conjunctival hyperaemia?
Find out if acute or chronic and work out cause
Stop CL wear if necessary
Change solutions
Bleph/MGD management
Check routine - remind of rub and rinse
Comfort drops
Find out about meds
Review and refer if necessary
What are some possible differential diagnoses of bulbar conjunctival hyperaemia?
Subconjunctival Haemorrhage
CLARE
What is CLARE?
What does it stand for?
Contact Lens Acute Red Eye
What are the features/causes of CLARE?
Features: Unilateral
Red, swollen eye from inflammatory response
Causes: Overwear/poor hygiene/sleeping/EW in CLs
What are the signs of CLARE?
Corneal infiltrates near limbus
AC flare
Endothelial bedewing
Conjunctival and limbal hyperaemia
What are the symptoms of CLARE?
AM onset
Pain
Tearing
Photophobia
How should CLARE be managed?
Stop CL wear until no infiltrates
No EW, change to DDs
Review same day to check sxs reducing
Improve lens hygiene/routine
Refit with looser lens
Therapeutic treatment if infiltrate >0.5mm
What is pinguecula and what is it’s management?
Chronic UV exposure has caused a degeneration of collagen fibres resulting in a yellow bump on sclera.
Asymptomatic
Surgical removal (rare)
Make sure lens doesn’t aggravate bump/s
What is pterygium and what is it’s management?
Chronic UV exposure has caused fibrovascular tissue to grow, invading cornea
Asymptomatic until grows over pupil
Surgical removal (if over pupil)
Fit with soft CL or small RGP if flat
When should limbal hyperaemia be managed?
> grade 1.5-2
OR > 1 grade change
OR if symptomatic
How should limbal hyperaemia be managed?
Change lens type to better Dk
SAME AS CONJ. REDNESS:
Find out if acute or chronic and work out cause
Stop CL wear if necessary
Change solutions
Bleph/MGD management
Check routine - remind of rub and rinse
Comfort drops
Find out about meds
Review and refer if necessary
What are possible differential diagnoses of limbal hyperaemia?
Limbal neovascularisation
Superior limbic keratoconjunctivitis
What is superior limbic keratoconjunctivitis?
Delayed allergic reaction to sols or deposits and mechanical damage/hypoxia under upper lid
What are dellen?
Dry spots from separation of lid from ocular surface (often caused by elevated structures like pterygium)
What are the symptoms of dellen?
FB sensation
Mild photophobia
How do you manage dellen?
Remove cause
Lubricants
What is vascularised limbal keratitis? What causes it?
Localised desiccation at 3 and 9 o’clock on the limbus.
Caused by EW or RGPs
What type of staining can occur in vascularised limbal keratitis?
3 and 9 o’clock staining
What are the symptoms of vascularised limbal keratitis?
Mild dryness
Mild lens awareness
Discomfort (if severe)
What are the signs of vascularised limbal keratitis?
Increased tissue and inflammation on limbus at 3 and 9 o’clock
Limbal vessel encroachment
Superficial punctate staining
Mild corneal infiltrates near limbus
How should vascularised limbal keratitis be managed?
No CLs for 1-3 days
Refit to DDs if EW
Refit RGP with flatter peripheral curves/smaller diameter or to soft lens
What factors increase limbal redness?
Hypoxia
Hypercapnia
Infection
Inflammation
Trauma from damaged lens
Solution toxicity or hypersensitivity
Lens deposits