Contact Lens Complications Flashcards
How would u manage a cl problem
A- intervene
Ie change lens solution or theraputic. Even refer
B- modify
The existing wearing time /advise and manage expectations and review this Px
What are the contact lens complications
- Hypoxia / hypercapnia
- Infection
- Allergy and toxicity
- mechanical effects
- Osmotic effects
What are the categories of corneal:conjunctival response?
Note there’s 8
- Distortion
- Epithelial staining
- Endothelial changes
- Palpebral inflammation
- Sx
- Hyperemia and vascularisation
- Infiltrates and opacities
- Tear film instability
- Distortion as a cl complication. What is it. How would u manage it?
A disruption to strength of cornea. Can be due to keratoconus- refit with RGP- maybe to a specialist. or cl overwear- recheck fit and perhaps fit a thinner cl or refer if no known cause. Be sure to review regularly to see if problem persists
- What’s epithelial staining. What’s some of the common types
Damage and depression to cornea.
- What endothelial changes can occur with contact lens complications. And how would u manage it
Polymegathism/ polymorphism
Normally regular hexagonal shape- hypoxic changes - can see blobs/ odeama, endothelial folds, kp
Also reduction in number with age
Refit with higher water content or SiH.
Is there also staining? 3&9 o’clock then fit with a larger lens.
What about peroxide cleaning sols, antibiotics or tear supplements?
Reduce WT, or even stop and see if reduction.
Advise Px of sx
Microbial keratitis and contact lens peripheral ulcer. As seen as confluent staining on the epithelium
Mk is well serious. Sight threatening.
CLPU is less serious and not sight threatening. Seen as confluent staining. On low illumination and low mag. For CLPU it will look circular and less than 1mm. Whereas MK will look irregular and bigger than 1mm and probs also have anterior chamber flare and cells. Sx- discomfort, FB sensation, itching, pain maybe say photophobia, tearing, redness, blurred vision. When u take cl out for CLPU sx improve. But for mk sx worsen. CLPU usually resolves normally. If worsens then mk. Treat. Emergency treatment with anti-microbial therapy- may need corneal graft.
DD- corneal abrasion, FB, non cl related ulcer.
- What are the different types of palpebral conjunctival inflammation ?
- Hyperaemia- increased BF usually first signs of inflammation
- Papillae- raised areas of inflammation on BV. Junctional papillae is normal. Micro papillae is less than 0.3mm. Macro papillae is between 0.3-1mm. Giant papillae is bigger than 1mm
- Follicles- from a viral infection white blood cells
- Concretions- pale yellow accumulations of inorganic matter beneath the epithelium. Removed by tip of needle
- How would u manage palpebral changes
Fit with a thinner lens? DD Move to a non ionic material Peroxide sol- always a choice to make Refer /treat with anti histamines Always reduce wt As kid on sx of inflammatory reaction Review to see of reduced
- What are symptoms cl complication Px get?
U look for them but also ask them too
Address initial RFV
Visual loss- could be Bv prob, altered corneal shape, tear film abnormally, odeama, IK, lens deposits, loss of lens
Discomfort- solution hypersensitivity/toxicity, edema, FB, epithelial disruption, deposits, excess movement of lens
- What hyperaemia and vascularisation changes can occur and how would u manage it?
Occur on conjuctiva or even bulbar. So for these Px u fit with a soft cl. Or high dk/t. Change for to flatter and larger diameter. Change to peroxide- not preservatives. Refer or treat with libricating drops. Reduce wt. Make Px aware of sx. Review.
How would u manage cl complication.
INTERVENE
Change cl type- new lens of same type? Change to DD. Increase in water content. Base curve or diameter change. To a soft/RGP. Tories/bifocals
Change care regime- change to peroxide. Include surfactants. Check preservatives. Allergic to one? Toxicity
Treat or refer- OTC drugs such as comfort drops or even artificial tears. Can refer to more qualified Optom
MODIFY EXISTING
Alter WT- reduce wt. Change mode of wear. If monthly lens wear only for 2/ weeks. Don’t do EW
Make Px aware of any sx- advise on every visit. What to expect. What signs to look out for. Write any info down. Contraindications?
Then u review. For continuity. And compliance. Routine appts every 3-12 months. If any complications reive quicker.
- What are infiltrates and opacities?
It is the damage to the cornea in different layers depending on the type and severity.
Split into three.
1. Clinically non significant and asymptomatic- asymptomatic infiltrate and asymptomatic infiltrate keratitis
2. Clinically significant and symptomatic. Infiltrate keratitis, CLARE, CLPU
3. SERIOUS AND SIGHT THREATENING
MK
- Whys it important for a good tear film?
To supply nutrients For comfort and allow movement of cl Corneal transparency Remove debris Protective layer
- What are the layers of the tear film
- Mucin. The glue
- Aqueous transparent system
- Lipid. Evaporation control
- How would u manage tear film abnormalities
Change lens to a SiH or low water lens. Change care system maybe?? Give lubricating drops. Reduce WT. Advise on dry eye. Tell them about omega 3, even prim rose oil. Review.
- How would u know of a tear abnormality.
Tear meniscus of less than 0.2 mm
Phenol red test is less than 3mm after 15seconds
Contact lens deposits. What do u know
Usually appear within 30mins. Rate varies. Soft lenses accumulate quicker than hard.
Group 4 attract more proteins
What are the cl groups
1 non ionic low water content
2 non ionic and high water content
3 ionic and low water content
4 ionic and high water content
What are the sources of lens deposits
From tears
-outer lipid layer
Middle aqueous layer
And mucous layer
Also from environment So from dust Makeup Medicines And care solutions
What are the types of lens deposits.
Protein- most diff to remove Lipid- smeary and greasy vision. Can be removed using surfactants Mucin- white surface films Calcium- white spots Fungal Makeup
How would u manage a Px with cl deposits. You were one. So wot did they do with u
Change lens type Change lens material/ group Change solutions. Surfactant Go to peroxide? Increase replacement frequency
What’s a protein contact lens complication
Most common Positively charged Most common in group 3&4=ionic lenses Causes visual disturbances and cl intolerance May lead to tarsal changes ??
Lipid contact lens complication:
Common in group 2- Hwc and non ionic
From tears
Made worse by Mgd or makeup
Decreased comfort and va
Spots on cl
Usually calcium but could be protein or lipid
Most common in group 2
Poor blinking or even insufficient tears
Blurred va? Discomfort?
Fungal cl complication
Rare. Due to poor hygiene or ineffective cleaning solutions. Usually no sx or slight discomfort
Damage to cl can be a problem
Maybe due to manufacturer
Poor lens handling
Lens trapped
Can lead to discomfort or even mechanical effects
Wetting probs
Mostly in RGP.
Poor tears. Deposits. Cosmetics. Poor polish on a RGP. MGD.
Could give u cl intolerance and variable Va
What are some common cl related probs:
- An abrasion. Sub conjunctival heammohrage. Due to lens insertion, nails or even FB. Increased fragility of epithelium. Fl staining. Discomfort. Pain. Photophobia. Remove cause and cease cl wear
- Dellen. Caused by dryness and dessication. Scaring and vascularisation at 3 and9 o’clock.
- Dessication. Discretion of cl surface. Incomplete blinking. Dryness sx? Refit lens. Or use lubricants.
- Dimple veiling. Central bubbles means too strap. In periphery then excessive edge lift. Refit.
- Exhaustion syndrome. Lack of 02. Too much c02. Corneal distortion. Monocular Diplopia.
- Giant papillae conjuctiva. Allergic of mechanical reaction. Enhance cleansing of lens.
- Hyperaemia. Engorgement of BV.
