Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Contact Lens Complications > Contact Lens Complications > Flashcards

Contact Lens Complications Flashcards

1
Q

Symptoms of CLPU

A

Moderate FB sensation/none
Redness
Mild photophobia
Symptoms reduce on lens removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Signs of CLPU

A

Distinctive, circular infiltrate towards periphery of cornea
Infiltrate has clearly defined margin, size 0.2-1.0mm
Overlying epithelial staining occurs early in the condition
Generally leaves a small scar which fades over time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CLPU Etiology

A

Non-infectious, infiltrative response to gram positive bacterial exotoxins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CLPU prevalence

A

Rare in daily wear, infrequent in extended wear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

CLPU Differential Diagnosis

A

Ulcerative keratitis
Infiltrates, marginal keratitis and CLARE
Herpes simplex, corneal dystrophies, stromal scar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CLPU Management

A

Cease lens wear immediately
If in doubt as to whether infectious or sterile, treat as infectious. Start topical antibiotic
Ocular lubricants, steroid/antibiotic combination topical treatment
Review within 24 hours
Recurrence is likely, limit extended wear to 6N
Consider daily disposables and lid hygiene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Smile Staining (Desiccation) Symptoms

A

None

Minor symptoms of dryness or discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Smile Staining Signs

A

Inferior arcuate staining of inferior cornea
Lesion is between 4 and 8 o’clock and is parallel to limbus
Often bilateral and asymmetric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Smile Staining Etiology

A

Localised disruption of the corneal surface as a result of desiccation
Often associated with incomplete blinking
More common with thin and high water content soft lenses
Lens dehydration leads to post lens tear film elimination and ultimately epithelial desiccation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Smile Staining Management

A

If staining is severe then cease lens where and use rewetting drops
Refit of persistent or severe to a low water content material, silicon hydrogel material
Rewetting drops
May need to reduce wearing time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Dimple Veiling Symptoms

A

None to mild irritation

May disturb vision if on visual axis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Dimple Veiling Signs

A

Indentations display and reversed illumination with white light illumination
Multiple, focal areas of sodium fluorescein pooling 

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Dimple Veiling Etiology

A

Indentations of epithelium resulting from air bubbles in rigid lenses or mucin balls in soft lenses trapped under lenses
Most frequently seen with ill fitting GP lenses or silicon hydrogel lenses
In GPs, observed centrally with excess pooling and peripherally with excessive edge lift

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dimple Veiling Management

A

Re-fit GP lens with closer alignment to corneal shape
Flatter base curve, smaller TD, change to toric back surface
Lens lubricants with EW silicon hydrogel, choose lens with a lower modulus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

FB Tracking Symptoms

A

May be asymptomatic
Discomfort mild to moderate


How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

FB Tracking Signs

A

Characteristic superficial linear disruption to corneal epithelium
Typically unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

FB Tracking Etiology

A

Epithelial abrasion due to presence of foreign body under a lens, damaged lens, make up brush, incorrect insertion/removal techniques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

FB Tracking Prevalence

A

Occasional
More common with rigid lens wear


How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

FB Tracking Management

A

Avoid predisposing environments
Use sunglasses or eye protection when GP lenses are worn outdoors to keep wind out of eyes
Remove lens and leave out for rest of the day
Re-teach insertion and removal
Replace damaged lens
Consider topical prophylactic antibiotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

SICS Symptoms

A

Frequently asymptomatic

Mild stinging or burning may be experienced on lens insertion and immediately following lens removal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

SICS Sign

A

Maximum staining often occurs after two hours of lens wear
Superficial punctate keratitis often in an annular pattern
Superficial punctate keratitis and may affect the entire corneal surface

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

SICS Etiology

A

Research is ongoing with respect to the cause of SICS
Staining may be indicative of cellular compromise
Some theories suggest that this illustrates the binding of fluorescein to epithelial cells with the contact lens preservative molecule acting as a binding agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

SICS Etiology

A

Common particularly with FDA group II hydrogels and silicon hydrogel materials when used with preserved care systems
Negligible with hydrogen peroxide and not present with daily disposables

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

SICS Management

A

Use solutions without added preservatives
Rinse lenses with saline prior to insertion, rubbing lenses with preserved care products prior to storage may also reduce the level of SICS
Select silicon hydrogel and disinfection solution combinations known to cause less solution related corneal staining
Switch to daily disposable lenses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

3 & 9 O’Clock Staining Symptoms

A

May be associated with lens intolerance, reduced wear time, dryness

26
Q

3 & 9 O’Clock Signs

A

Staining in the nasal and temporal cornea margins adjacent to the lens edge
Conjunctival hyperaemia along horizontal meridian


27
Q

3 & 9 O’Clock Etiology

A

Disruption of the epithelial surface due to tear film breakdown, incomplete blinking or desiccation

28
Q

3 & 9 O’Clock Prevalence

A

Common in rigid lens wearers

29
Q

3 & 9 O’Clock Management

A

Aim to improve the centration of the GP lens
Refit with a larger diameter lens and thinner edge design
Refit with a GP toric lens if the cornea is >2D toric
Refit with the silicon hydrogel if GP lens fitting cannot be improved
Ocular lubricants and/or blinking exercises

30
Q

Lipid Deposits Signs

A

None to mild discomfort, reduced vision

31
Q

Lipid Deposits Signs

A

Shimmering, oily film on the lens surface

32
Q

Lipid Deposits Etiology

A

Accumulation of lipid on soft lens surface
More common in silicon hydrogel and FDA group II hydrogels
May be poor tear film quality exacerbated by lid margin disease
Skincare products may deposit on lens during lens handling

33
Q

Lipid Deposits Management

A

Consider switching to daily disposable lenses
Change lens material
Review rub and rinse routine
Switch to solution with surfactant

34
Q

Protein Deposit Symptoms

A

Increased lens awareness

Itchiness - if develop CLPC due to presence of denatured protein

35
Q

Protein Deposit Signs

A

Uneven haziness on lens surface
Poor wetting
Palpebral conjunctival changes such as CLPC

36
Q

Protein Deposits Etiology

A

Sheets of denatured tear protein on lens surface

Occurs in predisposed individuals

37
Q

Protein Deposit Prevalence

A

Low levels are common

38
Q

Protein Deposits Management

A

Alter lens care regimen and encourage a rub and rinse step
Replace lenses and ensure patient is compliant with recommended lens replacement intervals
Switch to frequent replacement, daily disposable or GP lenses

39
Q

Superior Epithelial Arcuate Lesion (SEAL) Symptoms

A

None to mild discomfort

40
Q

SEAL Signs

A

Superficial arcuate staining of superior cornea
Lesion is between 10 and 2 o’clock and is parallel to limbus
Often unilateral and asymptomatic

41
Q

SEAL Etiology

A

Arcuate disruption of the peripheral corneal surface sparing the limbus
Likely to occur in superior region of cornea normally covered by the upper eyelid

42
Q

SEAL Prevalence

A

Rare

More common with EW and with stiffer lens materials (SiH)

43
Q

SEAL Management

A

Closely monitor for resolution if associated with EW lenses
If staining is more severe, then cessation of wear is required with the addition of rewetting drops
Refit is persistent to a DD, a higher water content, a more aspheric back surface, or lower modulus material

44
Q

Neovascularisation Symptoms

A

None but vision may be affected in deep stromal vascularisation due to associated opacities - superficial and deep stromal

45
Q

Neovascularisation Signs

A

Ingrowth of vessels in the cornea
Usually superficial but can also be deep stromal
Generally bilateral presentation
Superficial: corneal penetration by vessels continuous with the limbal vessels
Deep stromal: blood vessel growth in the stroma and vessels disappear from view at the limbus

46
Q

Neovascularisation Etiology

A

Due to chronic corneal hypoxia
Common signs associated with low Dk/t soft lens wearers
May be history of previous corneal disease, trauma, or infection

47
Q

Neovascularisation Prevalence

A

Rare with modern materials

48
Q

Neovascularisation Differential Diagnosis

A

Limbal hyperaemia

49
Q

Neovascularisation Management

A

Consider SiH lenses or GP lenses

50
Q

Contact Lens Papillary Conjunctivitis (CLAPC) Symptoms

A 
Intense itching
Lens awareness
Blurred vision
Lens likely to ride high
Px will experience unstable vision
51
Q

CLAPC Signs

A 
Papillae, >1mm diameter in GPC
Hyperaemia of the palpebral conjunctiva
Increased lens movement
Mucus discharge
Protein deposits on lens surface
52
Q

CLAPC Etiology

A

Allergic, mechanical, or combination reaction of superior conjunctival tarsal plate
More common in soft than GP lens wearers
Can be related to solution sensitivity to preservatives

53
Q

CLAPC Prevalence

A

Infrequent with disposable/frequently replaced lens materials
More common with stiffer lens materials

54
Q

CLAPC Differential Diagnosis

A

Vernal keratoconjunctivitis
Normal appearance of a few papillae around edge of tarsal plate (junctional conjunctiva)
Viral or follicular conjunctivitis

55
Q

CLAPC Management

A

Cease lens wear until inflammation subsides
Refit with DD or GP lenses or alternative soft lens materials
Reduce wearing time
Antihistamine and mast cell stabilisers combination therapy or steroid therapy
Refitting with DD benefits - thinner lens, less interation with lids, less protein deposits

56
Q

Contact Lens related Acute Red Eye (CLARE) Symptoms

A

Early morning, acute onset
Painful, red eye
Photophobia
Lacrimation

57
Q

CLARE Signs

A

Acute, usually unilateral, bulbar hyperaemia (>grade 2)

Small focal, diffuse peripheral infiltrates may be present

58
Q

CLARE Etiology

A

Inflammatory reaction of the cornea and conjunctiva usually following overnight lens wear
Due to contamination of the lens with gram negative bacteria
Often minimal or no corneal staining

59
Q

CLARE Prevalence

A

Rare in DW

Infrequent in EW

60
Q

CLARE Differential Diagnosis

A

Microbial Keratitis
Infiltrates and opacities
Hyperaemia

61
Q

CLARE Management

A

Cease wear immediately
Consider therapeutic treatment for large (>0.5mm) infiltrates, if diagnosis is uncertain or for significant discomfort
Review within 24 hours and confirm diagnosis
Wear may be resumed when infiltrates resolve. Hyperaemia resolves rapidly, infiltrate resolution may take several weeks
Reduce EW schedule after resolution, consider refit with looser lens or switch to DW. Discuss hygiene habits to prevent contamination of the lenses with bacteria

Contact Lens Complications (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions