Contact Lens Complications

Question 1

Symptoms of CLPU

Answer 1

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

Question 2

Signs of CLPU

Answer 2

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

Question 3

CLPU Etiology

Answer 3

Non-infectious, infiltrative response to gram positive bacterial exotoxins

Question 4

CLPU prevalence

Answer 4

Rare in daily wear, infrequent in extended wear

Question 5

CLPU Differential Diagnosis

Answer 5

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

Question 6

CLPU Management

Answer 6

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

Question 7

Smile Staining (Desiccation) Symptoms

Answer 7

None

Minor symptoms of dryness or discomfort

Question 8

Smile Staining Signs

Answer 8

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

Question 9

Smile Staining Etiology

Answer 9

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

Question 10

Smile Staining Management

Answer 10

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

Question 11

Dimple Veiling Symptoms

Answer 11

None to mild irritation

May disturb vision if on visual axis

Question 12

Dimple Veiling Signs

Answer 12

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

Question 13

Dimple Veiling Etiology

Answer 13

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

Question 14

Dimple Veiling Management

Answer 14

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

Question 15

FB Tracking Symptoms

Answer 15

May be asymptomatic
Discomfort mild to moderate


Question 16

FB Tracking Signs

Answer 16

Characteristic superficial linear disruption to corneal epithelium
Typically unilateral

Question 17

FB Tracking Etiology

Answer 17

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

Question 18

FB Tracking Prevalence

Answer 18

Occasional
More common with rigid lens wear


Question 19

FB Tracking Management

Answer 19

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

Question 20

SICS Symptoms

Answer 20

Frequently asymptomatic

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

Question 21

SICS Sign

Answer 21

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

Question 22

SICS Etiology

Answer 22

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

Question 23

SICS Etiology

Answer 23

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

Question 24

SICS Management

Answer 24

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

Question 25

3 & 9 O’Clock Staining Symptoms

Answer 25

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

Question 26

3 & 9 O’Clock Signs

Answer 26

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

Question 27

3 & 9 O’Clock Etiology

Answer 27

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

Question 28

3 & 9 O’Clock Prevalence

Answer 28

Common in rigid lens wearers

Question 29

3 & 9 O’Clock Management

Answer 29

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

Question 30

Lipid Deposits Signs

Answer 30

None to mild discomfort, reduced vision

Question 31

Lipid Deposits Signs

Answer 31

Shimmering, oily film on the lens surface

Question 32

Lipid Deposits Etiology

Answer 32

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

Question 33

Lipid Deposits Management

Answer 33

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

Question 34

Protein Deposit Symptoms

Answer 34

Increased lens awareness | Itchiness - if develop CLPC due to presence of denatured protein

Question 35

Protein Deposit Signs

Answer 35

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

Question 36

Protein Deposits Etiology

Answer 36

Sheets of denatured tear protein on lens surface | Occurs in predisposed individuals

Question 37

Protein Deposit Prevalence

Answer 37

Low levels are common

Question 38

Protein Deposits Management

Answer 38

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

Question 39

Superior Epithelial Arcuate Lesion (SEAL) Symptoms

Answer 39

None to mild discomfort

Question 40

SEAL Signs

Answer 40

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

Question 41

SEAL Etiology

Answer 41

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

Question 42

SEAL Prevalence

Answer 42

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

Question 43

SEAL Management

Answer 43

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

Question 44

Neovascularisation Symptoms

Answer 44

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

Question 45

Neovascularisation Signs

Answer 45

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

Question 46

Neovascularisation Etiology

Answer 46

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

Question 47

Neovascularisation Prevalence

Answer 47

Rare with modern materials

Question 48

Neovascularisation Differential Diagnosis

Answer 48

Limbal hyperaemia

Question 49

Neovascularisation Management

Answer 49

Consider SiH lenses or GP lenses

Question 50

Contact Lens Papillary Conjunctivitis (CLAPC) Symptoms

Answer 50

``` Intense itching Lens awareness Blurred vision Lens likely to ride high Px will experience unstable vision ```

Question 51

CLAPC Signs

Answer 51

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

Question 52

CLAPC Etiology

Answer 52

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

Question 53

CLAPC Prevalence

Answer 53

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

Question 54

CLAPC Differential Diagnosis

Answer 54

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

Question 55

CLAPC Management

Answer 55

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

Question 56

Contact Lens related Acute Red Eye (CLARE) Symptoms

Answer 56

Early morning, acute onset Painful, red eye Photophobia Lacrimation

Question 57

CLARE Signs

Answer 57

Acute, usually unilateral, bulbar hyperaemia (>grade 2) | Small focal, diffuse peripheral infiltrates may be present

Question 58

CLARE Etiology

Answer 58

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

Question 59

CLARE Prevalence

Answer 59

Rare in DW | Infrequent in EW

Question 60

CLARE Differential Diagnosis

Answer 60

Microbial Keratitis Infiltrates and opacities Hyperaemia

Question 61

CLARE Management

Answer 61

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