Contact Lens Pathology Review Flashcards
This is a comprehensive deck containing 2-5 different images for each pathology to ensure you can recognize different examples and not just memorize a single image. (Under Construction)
1
Q
A
Bullous Keratopathy
- degenerative condition in which the cornea becomes permanently swollen because the corneal endothelium has been damaged and is not pumping fluid properly
- pockets of fluid (‘bullae’) form in corneal tissue and rise to the epithelial surface where they break and become painful
- endothelial damage may be from trauma, glaucoma, or inflammation after some types of ocular surgery
- NO CONTACT LENSES
2
Q
A
Conjunctivitis
- inflammation of the conjunctiva
- allergic – discontinue contact lens wear for the duration
- viral or bacterial – discontinue contact lens wear for the duration, and dispose of soft contact lenses (or disinfect GPs) to prevent reinfection
3
Q
A
Trichiasis
- misdirection of the eyelashes toward the globe
- often associated with entropion or blepharitis, but can also occur on its own
- surgical management involves rotating the marginal part of the eyelid outwards, away from the globe, so that the lashes are no longer in contact with the eye
- prior to treatment a therapeutic (bandage), soft contact lens can be used to protect the eye from the irritating lashes
4
Q
A
Corneal Edema
- swelling due to hypoxia (lack of oxygen)
- causes include: tight lenses, low Dk soft or RGPs, PMMA lenses, extended wear of regular hydrogel lenses
- symptoms of acute edema include: extreme pain, excessive lacrimation, reduced vision, photophobia, intolerance of CL wear
- may cause microcysts in the epithelium
- symptoms of chronic edema are more subtle - less pain, and little to no effect on vision
- CLs must be discontinued until edema resolves
5
Q
A
Blepharoptosis/Ptosis
- drooping of the upper eyelid
- may cause difficulty with contact lens centration, but if a satisfactory fit can be obtained contact lens wear can be successful
6
Q
A
Hudson-Stähli Line
- an orange-brown iron line at the level of the basement membrane of the epithelium in the band region of the normal cornea
- roughly horizontal line found in the middle third of the cornea
- common in older corneas, and injured corneas at any age
7
Q
A
Bacterial Conjunctivitis
inflamation of the conjunctiva caused by a bacterial infection, often characterized by the presence of a purulent discharge
8
Q
A
Bacterial Corneal Ulcer
- presents with dense grayish white opacity associated with epithelial loss and stromal involvement – ulceration, stromal abscess formation, surrounding corneal edema, and anterior segment inflammation are characteristic of this disease – requires laboratory evaluation
- rapid progression; corneal destruction may be complete in 24-48 hours with some of the more virulent bacteria
- loss of vision or of eye are possible
- contact lens use increases the risk (bacteria can reside in deposits on lenses)
9
Q
A
Marginal Keratitis
- an infiltrative immune response to staphylococcal exotoxins which form intraepithelial infiltrates in the mid-peripheral cornea. Lesions (0.5 to 1.5 mm in diameter and may be flat or raised) are always islands, single or multiple on the peripheral margin, separated by clear cornea
- corneal edema is usually mild to moderate and can produce a haze around the infiltrates. Corneal involvement is most vulnerable at the 4 o’clock and 8 o’clock positions, but lesions may also be superior or circumlimbal. The bulbar conjunctiva is hyperemic
- unilateral painful watery eyes with sandy/gritty sensation
- treatment depends on the degree of presentation and includes warm compresses, broad-spectrum antibiotics, and steroids. cycloplegic drops decrease pain by limiting pupil dilation and contraction
- discontinue CLs until condition clears
10
Q
A
Recurrent Corneal Erosion (Image: Corneal Abrasion)
- symptoms: acute pain associated with lacrimation, photophobia, and a foreign body sensation
- may be associated blepharospasm and blurring of the vision
- symptoms may subside over the course of the day and start again in the morning upon opening the eyes (movement of eyelid removes newly formed epithelial cells) - unpredictable, leads to anxiety
- vision is rarely permanently affected, but complications include infectious keratitis, corneal scarring, possibility of decreased VA
- treat with lubricating ointment nightly for three months (even after symptoms subside), or sometimes a bandage/therapeutic lens
11
Q
A
Cataract
clouding of the crystalline lens, congenital or with age
12
Q
Hypoxia
A
Corneal Hypoxia
- caused by an insufficient supply of oxygen to the cornea as a result of contact lens wear
- the underlying cause of many complications of contact lens wear and the most common cause of corneal edema
- to treat hypoxia, the water content or oxygen permeability of the lenses should be increased by reducing lens thickness or changing lens material. patient can also remove and rehydrate lenses more frequently
13
Q
A
Microcornea
- a smaller than normal cornea with an HVID of 10mm or less, often very steep
- fit with an appropriately steep base curve
14
Q
A
Recurrent Corneal Erosion (Image: Corneal Abrasion)
- symptoms: acute pain associated with lacrimation, photophobia, and a foreign body sensation - usually occur on waking
- may be associated blepharospasm and blurring of the vision
- symptoms may subside over the course fo the day and start again in the morning upon opening the eyes (lid movement removes newly formed epithelial cells) – unpredictable, leads to anxiety
- vision is rarely permanently affected, but complications include infectious keratitis, corneal scarring, possibility of decreased VA
- treat with lubricating ointment nightly for three months (even after symptoms subside), or sometimes a bandage/therapeutic lens to protect newly forming cells
15
Q
A
Scars from Radial Keratotomy
a surgery performed to correct myopia
16
Q
A
Acanthamoeba Keratitis
- caused by parasites that can be found in soil, fresh, brackish, and sea water, hot springs, sewage, swimming pools, or on improperly cleaned contact lens equipment
- affects primarily the cornea and sclera
- If not treated properly and immediately, this disease can result in complete loss of vision
- more common in CL wearers because deposits on lenses can give the parasite something to hold onto and prevent it from being flushed out by tears
17
Q
A
Dimple Veiling
a bubble under a RGP that has broken up into lots of tiny bubbles
this makes “dimples” in the epithelium that will pool with fluorescein immediately after the lens is removed but will disappear within a few minutes
18
Q
A
Acanthamoeba Keratitis
- caused by parasites that can be found in soil, fresh, brackish, and sea water, hot springs, sewage, swimming pools, or on improperly cleaned contact lens equipment
- affects primarily the cornea and sclera
- If not treated properly and immediately, this disease can result in complete loss of vision
- more common in CL wearers because deposits on lenses can give the parasite something to hold onto and prevent it from being flushed out by tears
19
Q
A
Blepharoptosis/Ptosis
- drooping of the upper eyelid
- may cause difficulty with contact lens centration, but if a satisfactory fit can be obtained, contact lens wear can be successful
20
Q
A
Conjunctivitis
- inflammation of the conjunctiva
- allergic – discontinue contact lens wear for the duration
- viral or bacterial – discontinue contact lens wear for the duration, and dispose of soft contact lenses (or disinfect GPs) to prevent reinfection
21
Q
A
Superior Limbic Keratoconjunctivitis (SLK)
- an inflammatory reaction induced by wearing soiled hydrogel lenses, which cause excessive movement
- signs include intense laxity and hyperemia of the superior bulbar conjunctiva, fine papillary hypertrophy of superior tarsal conjunctiva, epithelial and subepithelial infiltrates, and superior corneal and limbal punctate staining
- treatment is temporary discontinuation of lens wear for several weeks to months – old lenses should be discarded, and frequent replacement of lenses (preferably switching to daily disposable) or switching to GPs is urged
- Theodore SLK (associated with thyroid disfunction) must be ruled out
22
Q
A
Fleischer’s Ring
- a type of pigmented dystrophy consisting of partial or complete iron deposition in the deep epithelium encircling the base of the cone in eyes with keratoconus
- appears as a yellowish to dark-brown coloured ring and can best be seen using a cobalt blue light with a slit lamp
23
Q
A
Krukenberg’s Spindle
- brownish, vertical, spindle-shaped pigment deposits on the posterior cornea
- look for old uveitis or pigment dispersion syndrome
- all patients who have Krukenberg’s spindle should be closely monitored for glaucoma
24
Q
A
Corneal Abrasion
an abrasion of the cornea caused by a foreign body or other mechanical irritation
makes the eye more susceptible to infection
contact lens wear should be discontinued until it heals unless there is recurrent corneal abrasion/erosion (where the eyelid opening in the morning removes the newly formed epithelial cells – in this case a bandage lense can be used to facilitate healing by giving the new epithelial cells more time to become integrated into the corneal structure
25
Q
A
Nevus (plural = nevi)
a benign pigment deposit on the eye
(similar to a mole or freckle on your skin)
26
Q
A
Corneal Dystrophy
- Epithelial basement membrane dystrophy (EBMD), also known as Cogan’s dystrophy or map-dot-fingerprint dystrophy, consists of grayish patches (maps), clear or white microcysts (dots), or swirls or lines (fingerprints) within the epithelium, best seen with retroillumiation
- GP lenses often help improve acuity and are not contraindicated for EBMD unless there is erosion of the epithelium
- epithelial erosions (recurrent erosion) occur in approximately 10% of all cases and cause great pain, patients may be fit with a high-water soft bandage contact lens, if needed
27
Q
A
Microcysts
- an accumulation of fluid in the intracellular space resulting from ruptured epithelial cell membranes, usually caused by adverse reaction to chemicals in some preserved contact lens solutions
- easily viewed with retroillumination
- symptoms include discomfort on lens insertion, photophobia, and epiphora (overflow of tears)
- discontinue use of offending chemicals (ie change CL solutions)
28
Q
A
Dendritic Ulcer
- characteristic of the herpes simplex type 1 virus
- distinctive “tree-branch” formation
- can recur over the lifetime of the patient
- discontinue CL wear until outbreak subsides and discard soft lenses or disinfect GPs
29
Q
A
Cataract
clouding of the crystalline lens, congenital or due to age
30
Q
A
Hordeolum
- AKA stye — a tender lump within the eyelid causing redness of the skin
- An internal hordeolum is caused by an infected meibomian gland and may evolve into a chalazion
- An external hordeolum is caused by an infection of the glands of Zeiss or Moll
31
Q
A
Corneal Neovascularization
- blood vessels growing into the normally avascular cornea, frequently due to oxygen deprivation from over-worn or improperly fit contact lenses
- neovascularization of more than 2mm is considered abnormal
- may result in lipid degeneration, pannus, scarring, intra-stromal hemorrhages, and eventually, reduced visual acuity
- treatment is to remove the causative factor (eg refit or discontinue CLs); the vessels may empty and become “ghost vessels.”
32
Q
A
Nevus (plural = nevi)
a benign pigment deposit on the eye
(similar to a mole or freckle on your skin)
33
Q
A
Dimple Veiling
a bubble under a RGP that has broken up into lots of tiny bubbles
this makes “dimples” in the epithelium that will pool with fluorescein immediately after the lens is removed but will disappear within a few minutes
34
Q
A
Kayser-Fleischer Ring
- an orange-brown/golden-brown/greenish-brown coloration visible around the edges of the cornea
- located in the posterior cornea at the level of Descemet’s membrane.
35
Q
A
Microcysts
- an accumulation of fluid in the intracellular space resulting from ruptured epithelial cell membranes, usually caused by adverse reaction to chemicals in some preserved contact lens solutions
- easily viewed with retroillumination
- symptoms include discomfort on lens insertion, photophobia, and epiphora (overflow of tears)
- discontinue use of offending chemicals (ie change CL solutions)
36
Q
A
Subconjunctival Hemorhage/Hematoma
blood pooling under the conjunctiva and creating a red patch on the sclera
37
Q
A
Keratoconus
- progressive thinning of the cornea causing it to bulge forward in a cone shape and causing irregular astigmatism among other vision problems
- once moderate to advanced, eyeglasses cannot achieve adequate visual acuity
- fit with GP or scleral lenses
38
Q
A
Subconjunctival Hemorhage/Hematoma
blood pooling under the conjunctiva and creating a red patch on the sclera
39
Q
A
Pterygium
- a triangle-shaped overgrowth of the conjunctiva that crosses the limbal border and encroaches onto the cornea
- often caused by UV exposure
- can start as a pinguecula
- patients with pterygium should be carefully evaluated prior to consideration of contact lens fitting, as pterygium may lead to dellen formation
40
Q
A
Entropion (upper lid)
- eyelid rolling inward
- patients with entropion generally require eyelid surgery or removal of some lashes, prior to which a therapeutic (bandage) soft contact lens can be used to protect the eye from the irritating lashes
41
Q
A
Corneal Dystrophy
- Epithelial basement membrane dystrophy (EBMD), also known as Cogan’s dystrophy or map-dot-fingerprint dystrophy, consists of grayish patches (maps), clear or white microcysts (dots), or swirls or lines (fingerprints) within the epithelium, best seen with retroillumiation
- GP lenses often help improve acuity and are not contraindicated for EBMD unless there is erosion of the epithelium
- epithelial erosions (recurrent erosion) occur in approximately 10% of all cases and cause great pain, patients may be fit with a high-water soft theraputic/bandage contact lens, if needed
42
Q
A
Pannus
- deep stromal neovascularization (as compared to fine, superficial neovascularization)
- fibrovascular connective tissue proliferates into the anterior layers of the peripheral cornea in inflammatory corneal disease
- can be caused by overwear of contact lenses
- patients with pannus should not be fit with contact lenses
- if a patient is currently wearing lenses, lenses should be discontinued
43
Q
A
Eyelid Retraction in Graves’ Disease
- Graves’ disease is an autoimmune disease that can cause hyperthyroidism
- patients may also present with optic neuropathy
- RGP contact lenses are generally unsuccessful due to poor centration
- soft contact lens wear may be successful, frequently with supplemental artificial tears
44
Q
A
Entropion (lower lid)
- eyelid rolling inward
- patients with entropion generally require eyelid surgery or removal of some lashes, prior to which a therapeutic (bandage) soft contact lens can be used to protect the eye from the irritating lashes
45
Q
A
Corneal Abrasion
an abrasion of the cornea caused by a foreign body or other mechanical irritation
makes the eye more susceptible to infection
contact lens wear should be discontinued until it heals unless there is recurrent corneal abrasion/erosion (where the eyelid opening in the morning removes the newly formed epithelial cells – in this case a bandage lense can be used to facilitate healing by giving the new epithelial cells more time to become integrated into the corneal structure
46
Q
A
Hyphema
blood in the anterior chamber
47
Q
A
Meibomian Gland Dysfunction
- The meibomian glands over-secrete and become blocked/plugged
- MGD is a major cause of both chronic blepharitis and keratoconjunctivitis sicca (dry eye)
48
Q
A
Corneal Folds and Striae
- Folds appear as long, straight lines and striae appear as fine white vertical lines in the posterior stroma
- both may occur in the presence of corneal edema
- more commonly seen in patients who wear extended wear lenses or high plus hydrogel lenses.
- patient may be asymptomatic or have issues with glare
- management requires refitting the patient in a higher Dk lens or changing to daily wear lenses.
49
Q
A
Corneal Dystrophy
- Epithelial basement membrane dystrophy (EBMD), also known as Cogan’s dystrophy or map-dot-fingerprint dystrophy, consists of grayish patches (maps), clear or white microcysts (dots), or swirls or lines (fingerprints) within the epithelium, best seen with retroillumiation
- GP lenses often help improve acuity and are not contraindicated for EBMD unless there is erosion of the epithelium
- epithelial erosions (recurrent erosion) occur in approximately 10% of all cases and cause great pain, patients may be fit with a high-water soft bandage contact lens, if needed
50
Q
A
Pterygium
- a triangle-shaped overgrowth of the conjunctiva that crosses the limbal border and encroaches onto the cornea
- often caused by UV exposure
- can start as a pinguecula
- patients with pterygium should be carefully evaluated prior to consideration of contact lens fitting, as pterygium may lead to dellen formation
51
Q
A
Giant Papillary Conjunctivitis (GPC)
- identifiable by papillae (large bumps) over the tarsal palpebral conjunctiva of the upper lid, visible when inverted.
- caused by a foreign body (frequently an improperly cleaned, damaged, or over-worn contact lens) mechanically irritating the eye
- discontinue contact lens use until the problem is resolved, and re-educate on cleaning and wear time if necessary
52
Q
A
Hordeolum
- AKA stye — a tender lump within the eyelid causing redness of the skin
- An internal hordeolum is caused by an infected meibomian gland and may evolve into a chalazion
- An external hordeolum is caused by an infection of the glands of Zeiss or Moll
53
Q
A
Keratitis
inflamation of the cornea
54
Q
A
Megalocornea
- a larger than normal cornea (usually presents bilaterally) with an HVID of 13mm or more, often with high refractive error and astigmatism
- 90% of megalocorneas are in males
- fit with a large (16 mm), flat soft contact lens for best centration
55
Q
A
Corneal Edema
- swelling due to hypoxia (lack of oxygen)
- causes include: tight lenses, low Dk soft or RGPs, PMMA lenses, extended wear of regular hydrogel lenses
- symptoms of acute edema include: extreme pain, excessive lacrimation, reduced vision, photophobia, intolerance of CL wear
- may cause microcysts in the epithelium
- symptoms of chronic edema are more subtle - less pain, an little to no effect on vision
- CLs must be discontinued until edema resolves
56
Q
A
Embedded Foreign Object
a foreign object embedded in the conjunctiva (as opposed to debris that is on the surface of the eye but able to move)
57
Q
A
Corneal Folds and Striae
- Folds appear as long, straight lines and striae appear as fine white vertical lines in the posterior stroma
- both may occur in the presence of corneal edema
- more commonly seen in patients who wear extended wear lenses or high plus hydrogel lenses.
- patient may be asymptomatic or have issues with glare
- management requires refitting the patient in a higher Dk lens or changing to daily wear lenses.
58
Q
A
Bacterial Conjunctivitis
inflamation of the conjunctiva caused by a bacterial infection, often characterized by the presence of a purulent discharge
59
Q
A
Keratitis
inflamation of the cornea
60
Q
A
Keratitis
inflamation of the cornea
this case is severe, resulting from the pseudomonas aeruginosa bacteria (lives in the mouth – eye infection can occur from using saliva to wet or “clean” contact lenses
61
Q
A
Giant Papillary Conjunctivitis (GPC)
- identifiable by papillae (large bumps) over the tarsal palpebral conjunctiva of the upper lid, visible when inverted.
- caused by a foreign body (frequently an improperly cleaned, damaged, or over-worn contact lens) mechanically irritating the eye
- discontinue contact lens use until the problem is resolved, and re-educate on cleaning and wear time if necessary
62
Q
A
Superior Limbic Keratoconjunctivitis (SLK)
- an inflammatory reaction induced by wearing soiled hydrogel lenses, which cause excessive movement
- signs include intense laxity and hyperemia of the superior bulbar conjunctiva, fine papillary hypertrophy of superior tarsal conjunctiva, epithelial and subepithelial infiltrates, and superior corneal and limbal punctate staining
- treatment is temporary discontinuation of lens wear for several weeks to months – old lenses should be discarded, and frequent replacement of lenses or switching to GPs is urged
- Theodore SLK (associated with thyroid disfunction) must be ruled out
63
Q
A
Pinguecula
- a growth on the conjunctiva most commonly caused by UV exposure
- may develop into a pterygium
- contact lenses may cause irritation – try to keep the edge of the lens away from the pinguecula by choosing a smaller lens that avoids contact, or a larger lens that vaults over it.
64
Q
A
Fleischer’s Ring
- a type of pigmented dystrophy consisting of partial or complete iron deposition in the deep epithelium encircling the base of the cone in eyes with keratoconus
- appears as a yellowish to dark-brown coloured ring and can best be seen using a cobalt blue light with a slit lamp
65
Q
A
Ectropion
- eyelid turning outward leaving the inner eyelid surface exposed
- contact lens fitting may be contraindicated if the contact lenses do not centre, or the tear reservoir is not adequate for ocular comfort and health
66
Q
A
Blepharitis
- dermatitis or eczema of the eyelid with crusting of the lashes, often causing inflammation, usually chronic
- whether contact lenses can be worn depends on the severity
- anterior blepharitis affects the outer front of the eyelid
- posterior blepharitis affects the underside of the front of the eyelid and the meibomian glands
67
Q
A
Embedded Foreign Object
a foreign object embedded in the conjunctiva (as opposed to debris that is on the surface of the eye but able to move)
this image also shows a subconjunctival hematoma
68
Q
A
Chalazion
- Results from the obstruction of one or more meibomian glands, causing the re-release of the gland’s contents into the surrounding soft tissue of the eyelid
69
Q
A
Lagophthalmos
- inability to fully close the eyelids, resulting in corneal exposure and subsequent keratopathy
- any patient with lagophthalmos is typically not a candidate for contact lenses unless a bandage contact lens is recommended
70
Q
A
Bullous Keratopathy
- degenerative condition in which the cornea becomes permanently swollen because the corneal endothelium has been damaged and is not pumping fluid properly
- pockets of fluid (‘bullae’) form in corneal tissue and rise to the epithelial surface where they break and become painful
- endothelial damage may be from trauma, glaucoma, or inflammation after some types of ocular surgery
- NO CONTACT LENSES
71
Q
A
Corneal Neovascularization
- blood vessels growing into the normally avascular cornea, frequently due to oxygen deprivation from over-worn or improperly fit contact lenses
- neovascularization of more than 2mm is considered abnormal
- may result in lipid degeneration, pannus, scarring, intra-stromal hemorrhages, and eventually, reduced visual acuity
- treatment is to remove the causative factor (eg refit or discontinue CLs); the vessels may empty and become “ghost vessels.”
72
Q
A
Cataract
clouding of the crystalline lens (congenital or due to age)
73
Q
A
Blepharitis
- dermatitis or eczema of the eyelid with crusting of the lashes, often causing inflammation, usually chronic
- whether contact lenses can be worn depends on the severity
- anterior blepharitis affects the outer front of the eyelid
- posterior blepharitis affects the underside of the front of the eyelid and the meibomian glands
74
Q
A
Kayser-Fleischer Ring
- an orange-brown/golden-brown/greenish-brown coloration visible around the edges of the cornea
- located in the posterior cornea at the level of Descemet’s membrane.
75
Q
A
Hypopion
pus in the anterior chamber
76
Q
A
Krukenberg’s Spindle
- brownish, vertical, spindle-shaped pigment deposits on the posterior cornea
- look for old uveitis or pigment dispersion syndrome
- all patients who have Krukenberg’s spindle should be closely monitored for glaucoma
77
Q
A
Nevus (plural = nevi)
a benign pigment deposit on the eye
(similar to a mole or freckle on your skin)
78
Q
A
Basal Cell Carcinoma
a type of skin cancer – do not diagnose, refer to a family doctor
79
Q
A
Corneal Dystrophy
- Epithelial basement membrane dystrophy (EBMD), also known as Cogan’s dystrophy or map-dot-fingerprint dystrophy, consists of grayish patches (maps), clear or white microcysts (dots), or swirls or lines (fingerprints) within the epithelium, best seen with retroillumiation
- GP lenses often help improve acuity and are not contraindicated for EBMD unless there is erosion of the epithelium
- epithelial erosions (recurrent erosion) occur in approximately 10% of all cases and cause great pain, patients may be fit with a high-water soft bandage contact lens, if needed
80
Q
A
Hyphema
blood in the anterior chamber
81
Q
A
Pterygium
- a triangle-shaped overgrowth of the conjunctiva that crosses the limbal border and encroaches onto the cornea
- often caused by UV exposure
- can start as a pinguecula
- patients with pterygium should be carefully evaluated prior to consideration of contact lens fitting, as pterygium may lead to dellen formation
82
Q
A
Pterygium
- a triangle-shaped overgrowth of the conjunctiva that crosses the limbal border and encroaches onto the cornea
- often caused by UV exposure
- can start as a pinguecula
- patients with pterygium should be carefully evaluated prior to consideration of contact lens fitting, as pterygium may lead to dellen formation
83
Q
A
Dendritic Ulcer
- characteristic of the herpes simplex type 1 virus
- distinctive “tree-branch” formation
- can recur over the lifetime of the patient
- discontinue CL wear until outbreak subsides and discard soft lenses or disinfect GPs
84
Q
A
Hypopion
pus in the anterior chamber
85
Q
A
Pannus
- deep stromal neovascularization (as compared to fine, superficial neovascularization)
- fibrovascular connective tissue proliferates into the anterior layers of the peripheral cornea in inflammatory corneal disease
- can be caused by overwear of contact lenses
- patients with pannus should not be fit with contact lenses
- if a patient is currently wearing lenses, lenses should be discontinued
86
Q
A
Marginal Keratitis
- an infiltrative immune response to staphylococcal exotoxins which form intraepithelial infiltrates in the mid-peripheral cornea. Lesions (0.5 to 1.5 mm in diameter and may be flat or raised) are always islands, single or multiple on the peripheral margin, separated by clear cornea
- corneal edema is usually mild to moderate and can produce a haze around the infiltrates. Corneal involvement is most vulnerable at the 4 o’clock and 8 o’clock positions, but lesions may also be superior or circumlimbal. The bulbar conjunctiva is hyperemic
- unilateral painful watery eyes with sandy/gritty sensation
- treatment depends on the degree of presentation and includes warm compresses, broad-spectrum antibiotics, and steroids. cycloplegic drops decrease pain by limiting pupil dilation and contraction
- discontinue CLs until condition clears
87
Q
A
Pinguecula
- a growth on the conjunctiva most commonly caused by UV exposure
- may develop into a pterygium
- contact lenses may cause irritation – try to keep the edge of the lens away from the pinguecula by choosing a smaller lens that avoids contact, or a larger lens that vaults over it.
88
Q
A
Corneal Abrasion
an abrasion of the cornea caused by a foreign body or other mechanical irritation
makes the eye more susceptible to infection
contact lens wear should be discontinued until it heals unless there is recurrent corneal abrasion/erosion (where the eyelid opening in the morning removes the newly formed epithelial cells – in this case a bandage lense can be used to facilitate healing by giving the new epithelial cells more time to become integrated into the corneal structure
89
Q
A
Eyelid retraction in Graves’ Disease
- Graves’ disease is an autoimmune disease that can cause hyperthyroidism
- patients may also present with optic neuropathy
- RGP contact lenses are generally unsuccessful due to poor centration
- soft contact lens wear may be successful, frequently with supplemental artificial tears
90
Q
A
Superficial Punctate Keratitis (SPK)
- symptoms are injection, lacrimation, photophobia, and slightly decreased vision
- diagnosis is made by slit-lamp examination
- treatment depends on the cause
91
Q
A
Pinguecula
- a growth on the conjunctiva most commonly caused by UV exposure
- may develop into a pterygium
- contact lenses may cause irritation – try to keep the edge of the lens away from the pinguecula by choosing a smaller lens that avoids contact, or a larger lens that vaults over it.
92
Q
A
Corneal Dystrophy
- Epithelial basement membrane dystrophy (EBMD), also known as Cogan’s dystrophy or map-dot-fingerprint dystrophy, consists of grayish patches (maps), clear or white microcysts (dots), or swirls or lines (fingerprints)
within the epithelium, best seen with retroillumiation - GP lenses often help improve acuity and are not contraindicated for EBMD unless there is erosion of the epithelium
- epithelial erosions (recurrent erosion) occur in approximately 10% of all cases and cause great pain, patients may be fit with a high-water soft bandage contact lens, if needed
93
Q
A
Meibomian Gland Dysfunction
- The meibomian glands over-secrete and become blocked/plugged
- MGD is a major cause of both chronic blepharitis and keratoconjunctivitis sicca (dry eye)
94
Q
A
Acanthamoeba Keratitis
- caused by parasites that can be found in soil, fresh, brackish, and sea water, hot springs, sewage, swimming pools, or on improperly cleaned contact lens equipment
- affects primarily the cornea and sclera
- If not treated properly and immediately, this disease can result in complete loss of vision
- more common in CL wearers because deposits on lenses can give the parasite something to hold onto and prevent it from being flushed out by tears
95
Q
A
Ectropion
- eyelid turning outward leaving the inner eyelid surface exposed
- contact lens fitting may be contraindicated if the contact lenses do not centre or the tear reservoir is not adequate for ocular comfort and health
96
Q
A
Keratoconjunctivitis Sicca (Dry Eye)
- diagnosis can be made based on TBUT (either subjective as reported by the patient or with the use of fluorescein)
- causes include: by decreased tear production, medication, hormonal changes, environmental factors, insufficient/incomplete blinking, refractive surgery, meibomian gland dysfunction, some systemic illnesses, entropion/ectropion, blockage in nasolacrimal duct system, etc.
- tear supplementation may be required
- SCLs or GPs may be worn if tolerated - may need to try different types (higher/lower water content, additives to retain/release moisture, more frequent replacement)
97
Q
A
Dimple Veiling
a bubble under a RGP that has broken up into lots of tiny bubbles
this makes “dimples” in the epithelium that will pool with fluorescein immediately after the lens is removed but will disappear within a few minutes
98
Q
A
Corneal Abrasion
an abrasion of the cornea caused by a foreign body or other mechanical irritation
makes the eye more susceptible to infection
contact lens wear should be discontinued until it heals unless there is recurrent corneal abrasion/erosion (where the eyelid opening in the morning removes the newly formed epithelial cells – in this case a bandage lense can be used to facilitate healing by giving the new epithelial cells more time to become integrated into the corneal structure
99
Q
A
Dendritic Ulcer
- characteristic of the herpes simplex type 1 virus
- distinctive “tree-branch” formation
- can recur over the lifetime of the patient
- discontinue CL wear until outbreak subsides and discard soft lenses or disinfect GPs
100
Q
A
Chalazion
- Results from the obstruction of one or more meibomian glands, causing the rerelease of the gland’s contents into the surrounding soft tissue of the eyelid
101
Q
A
Hudson-Stähli Line
- an orange-brown iron line at the level of the basement membrane of the epithelium in the band region of the normal cornea
- roughly horizontal line found in the middle third of the cornea.
- common in older corneas, and injured corneas at any age
102
Q
A
Bacterial Corneal Ulcer
- presents with dense grayish white opacity associated with epithelial loss and stromal involvement –ulceration, stromal abscess formation, surrounding corneal edema, and anterior segment inflammation are characteristic of this disease – requires laboratory evaluation
- rapid progression; corneal destruction may be complete in 24-48 hours with some of the more virulent bacteria
- loss of vision or of eye are possible
- contact lens use increases the risk (bacteria can reside in deposits on lenses)
103
Q
A
Corneal Neovascularization
- blood vessels growing into the normally avascular cornea, frequently due to oxygen deprivation from over-worn or improperly fit contact lenses
- neovascularization of more than 2mm is considered abnormal
- may result in lipid degeneration, pannus, scarring, intra-stromal hemorrhages, and eventually, reduced visual acuity
- treatment is to remove the causative factor (eg refit or discontinue CLs); the vessels may empty and become “ghost vessels.”
104
Q
A
Keratoconus
- progressive thinning of the cornea causing it to bulge forward in a cone shape and causing irregular astigmatism among other vision problems
- once moderate to advanced, eyeglasses cannot achieve adequate visual acuity
- fit with GP or scleral lenses
- this image demonstrates “Munsen’s Sign” which is used to identify the condition
105
Q
A
Arcus Senilis
peripheral corneal opacity caused by the depositing of phospholipids and cholesterol
appears as a hazy white, grey, or blue ring
common and benign in elderly patients
106
Q
A
Corneal Abrasion
an abrasion of the cornea caused by a foreign body or other mechanical irritation
makes the eye more susceptible to infection
contact lens wear should be discontinued until it heals unless there is recurrent corneal abrasion/erosion (where the eyelid opening in the morning removes the newly formed epithelial cells – in this case a bandage lense can be used to facilitate healing by giving the new epithelial cells more time to become integrated into the corneal structure
107
Q
A
Dendritic Ulcer
- characteristic of the herpes simplex type 1 virus
- distinctive “tree-branch” formation
- can recur over the lifetime of the patient
- discontinue CL wear until outbreak subsides and discard soft lenses or disinfect GPs
108
Q
A
Keratic Precipitates
- white or pigmented deposits on the endothelial surface
- suggestive of uveitis, trauma, or age.
109
Q
A
Basal Cell Carcinoma
a type of skin cancer – do not diagnose, refer to a family doctor
110
Q
A
Pannus
- deep stromal neovascularization (as compared to fine, superficial neovascularization)
- fibrovascular connective tissue proliferates into the anterior layers of the peripheral cornea in inflammatory corneal disease
- can be caused by overwear of contact lenses
- patients with pannus should not be fit with contact lenses
- if a patient is currently wearing lenses, lenses should be discontinued
111
Q
A
Arcus Senilis
peripheral corneal opacity caused by the depositing of phospholipids and cholesterol
appears as a hazy white, grey, or blue ring
common and benign in elderly patients
112
Q
A
Embedded Foreign Object
a foreign object embedded in the conjunctiva (as opposed to debris that is on the surface of the eye but able to move)
113
Q
A
Superficial Punctate Keratitis (SPK)
- symptoms are injection, lacrimation, photophobia, and slightly decreased vision
- diagnosis is made by slit-lamp examination
- treatment depends on the cause
114
Q
A
Giant Papillary Conjunctivitis (GPC)
- identifiable by papillae (large bumps) over the tarsal palpebral conjunctiva of the upper lid, visible when inverted.
- caused by a foreign body (frequently an improperly cleaned, damaged, or over-worn contact lens) mechanically irritating the eye
- discontinue contact lens use until the problem is resolved, and re-educate on cleaning and wear time if necessary
115
Q
A
Lagophthalmos
- inability to fully close the eyelids, resulting in corneal exposure and subsequent keratopathy
- any patient with lagophthalmos is typically not a candidate for contact lenses unless a bandage contact lens is recommended
116
Q
A
Hyphema
blood in the anterior chamber
117
Q
A
Embedded Foreign Object
a foreign object embedded in the conjunctiva (as opposed to debris that is on the surface of the eye but able to move)
118
Q
A
Subconjunctival Hemorhage/Hematoma
blood pooling under the conjunctiva and creating a red patch on the sclera
119
Q
A
Dellen
- focal, peripheral, saucer-shaped depressions adjacent to the limbus with sloped borders, approximately one half of the corneal thickness, producing a “hole-like” appearance usually at 3 and 9 o’clock
- associated with an adjacent raised mass such as the thick edge of a GP lens or pterygium
- thinning occurs in the epithelium, Bowman’s layer, and superficial stroma
- usually transient (24 to 48 hours) but may last for weeks and cause scarring
- discontinue GPs – a soft bandage lens may provide protection.
120
Q
A
Trichiasis
- misdirection of the eyelashes toward the globe
- often associated with entropion or blepharitis, but can also occur on its own
- surgical management involves rotating the marginal part of the eyelid outwards, away from the globe, so that the lashes are no longer in contact with the eye
- prior to treatment a therapeutic (bandage), soft contact lens can be used to protect the eye from the irritating lashes
121
Q
A
Keratoconus
- progressive thinning of the cornea causing it to bulge forward in a cone shape and causing irregular astigmatism among other vision problems
- once moderate to advanced eyeglasses cannot achieve adequate visual acuity
- fit with GP or scleral lenses
122
Q
A
Dellen
- focal, peripheral, saucer-shaped depressions adjacent to the limbus with sloped borders, approximately one half of the corneal thickness, producing a “hole-like” appearance usually at 3 and 9 o’clock
- associated with an adjacent raised mass such as the thick edge of a GP lens or pterygium
- thinning occurs in the epithelium, Bowman’s layer, and superficial stroma
- usually transient (24 to 48 hours) but may last for weeks and cause scarring
- discontinue GPs – a soft bandage lens may provide protection.
123
Q
A
Keratoconjunctivitis Sicca (Dry Eye)
- diagnosis can be made based on TBUT (either subjective as reported by the patient or with the use of fluorescein)
- causes include: by decreased tear production, medication, hormonal changes, environmental factors, insufficient/incomplete blinking, refractive surgery, meibomian gland dysfunction, some systemic illnesses, entropion/ectropion, blockage in nasolacrimal duct system, etc.
- tear supplementation may be required
- SCLs or GPs may be worn if tolerated - may need to try different types (higher/lower water content, additives to retain/release moisture, more frequent replacement)
124
Q
A
Keratic Precipitates
- white or pigmented deposits on the endothelial surface
- suggestive of uveitis, trauma, or age.
125
Q
A
Scars from Radial Keratotomy
a surgery performed to correct myopia
126
Q
A
Meibomian Gland Dysfunction
- The meibomian glands over-secrete and become blocked/plugged
- MGD is a major cause of both chronic blepharitis and keratoconjunctivitis sicca (dry eye)
127
Q
A
Dellen
- focal, peripheral, saucer-shaped depressions adjacent to the limbus with sloped borders, approximately one half of the corneal thickness, producing a “hole-like” appearance usually at 3 and 9 o’clock
- associated with an adjacent raised mass such as the thick edge of a GP lens or pterygium
- thinning occurs in the epithelium, Bowman’s layer, and superficial stroma
- usually transient (24 to 48 hours) but may last for weeks and cause scarring
- discontinue GPs – a soft bandage lens may provide protection.
128
Q
A
Conjunctivitis
- inflammation of the conjunctiva
- allergic – discontinue contact lens wear for the duration
- viral or bacterial – discontinue contact lens wear for the duration, and dispose of soft contact lenses (or disinfect GPs) to prevent reinfection
129
Q
A
1) Hypopion
pus in the anterior chamber
2) Subconjunctival Hemorhage/Hematoma
blood pooling under the conjunctiva and creating a red patch on the sclera
