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contact lens studies > contact lenses soft lenses and conditons > Flashcards

contact lenses soft lenses and conditons Flashcards

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1
Q

Daily hydrogel example

A

1 day acuvue moist (for astig) (mf) – J&J

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2
Q

Daily silicone hydrogel example

A

clarit 1 day (toric) (multifocal) – coopervision

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3
Q

Monthly hydrogel example

A

proclear (toric) (multifocal) – coopervision

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4
Q

Monthly silicone hydrogel example

A

Bioinfinity (XR) (toric) (MF) – coopervision

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5
Q

Dual licence example

A

acuvue oasys – weekly EW or fortnight normal wear (J&J)

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6
Q

RGP example

A

maxim 141 (toric)

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7
Q

Daily vs EW

A
  1. Corneal status
  2. Risk factors – oedema, diabetes etc
  3. Rx factors
  4. Tear film
  5. Lid integrity
  6. Individual characterisations – dexterity, preference etc
  7. Ocular dimensions
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8
Q

Selecting first lens:

A
  1. Modality
  2. Oxygen and water
  3. Material
  4. BOZR
  5. TD
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9
Q

multi purpose solution

A

common
designed for soft contact lenses
examples- CV all in one light

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10
Q

MPS steps for cl care

A
  1. Wash and dry hands
  2. 3 drops of MPS on each side of lens, rub gently for 20 seconds
  3. Rinse each side thoroughly
  4. Place clean CL in case and fill with fresh solution
  5. Soak for at least 4 hours
  6. Store lenses in closed clean case. Lenses may be stored in an unopened case ready to wear for 30 days max.
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11
Q

Case care:

A
  • When lenses removed, empty solution from case
  • Case should be rinsed with MPS or sterile saline
  • Make sure no residual solution is allowed to dry on case
  • Case and lids should be left to dry face down on a clean tissue
  • Lens case should be replaced monthly
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12
Q

Hydrogen peroxide

A

3% hydrogen peroxide has broad antimicrobial activity. It destroys pathogens by oxidation which results in protein denaturisation and damaged microbial cell membranes. It is preservative free. Requires catalyst to neutralise the hydrogen peroxide during disinfection – platinum disc/tablet. Disinfection usually takes 6 hours
Example – Bausch and lomb easy sept

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13
Q

Hydrogen peroxide steps:

A
  1. Wash/dry hands
  2. Remove lenses place in baskets and close baskets
  3. Rinse each lens in holder for 5 seconds with fresh peroxide solution
  4. Fill case of the line with peroxide solution
  5. Place lens holder inside lens case and close securely. Solution will start to bubble.
  6. Ensure case is in an upright position and lenses are fully immersed. Allow lenses to soak overnight for 6 hours
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14
Q

hydrogen peroxide cleaning

A

cleans debris and deposit build up. It enhances disinfection process and enhances wettability. It is important to rub lens to mechanically reduce debris. It also removes contaminants that supply nutrients to bacteria. Cleaning solutions contain surfactants and preservatives. The surfactant is used to clean the lens, example of surfactant is poloxamer

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15
Q

hydrogen peroxide disinfecting

A

reduction of the level of microorganisms to a degree that is safe for the ocular surface, without damming the contact lens. Disinfectants usually contain biocides, for example PHMB

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16
Q

hydrogen peroxide preservatives

A

restrict the growth of microorganisms and maintain sterility of solution in the bottle and contact lens case. Example is polyquad

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17
Q

hydrogen peroxide viscosity enhancers

A

improve wetting time and comfort of the solution. The agent increases thickness of the solution and gives in a smooth feel. Example is PVA

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18
Q

hydrogen peroxide tonicity adjusters

A

maintain the ideal CL salt solution of 0.9% sodium chloride. If the salt solution is too high the cornea may dry, if too low the cornea may swell. Example includes NaCl

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19
Q

hydrogen peroxide Buffers

A

used to stabilise pH between 7.0-7.4 in order to match the neutral tear film. Without a buffer there is a risk of epithelial damage. Example is bicarbonate

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20
Q

hydrogen peroxide chelating agents

A

prevent lens deposits (binds free ions such as calcium and magnesium). It has antimicrobial and disinfectant activity; it enhances the action of preservatives. Example is EDTA

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21
Q

hydrogen peroxide mild abbrasives

A

enhance the natural stripping of debris and proteins from the lens surface with polymetric beads

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22
Q

hydrogen peroxide re-wetting drops

A

often used in those with CL discomfort, once pathology is ruled out. rewetting drops give temporary relief for discomfort by mimicking natural tears that have evaporated too quickly e.g. renu multipurpose lubricating and rewetting drops

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23
Q

hydrogen peroxide deposits

A

extent of deposits increases over tine and include proteins, lipids, muscins and polysaccrides. The are less common nowadays. The decrease comfort etc and increase irritation. They may contain papin or pancreatin. Weekly cleaning is suggested.

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24
Q

Bulbat stainng aetiology

A

mechanical trauma of the conjuctival epithelium due to lens fit and design (tight fit, lens edge or decentration.

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25
Bulbar staining symptoms
-Px usually asymptomatic -Does not affect clinical performance of the lens -May occasionally present with dryness, itching, CL intolerance
26
Bulbar staining signs
- Staining of the bulbar conjunctiva with NaFl - Staining area often consists with edge of hydrogel lens
27
Bulbar staining management
- Only requires management if graded 2 or above - Flatter lens design – increase BOZR - Change material of lens i.e. SiHi - Change care systems if solution toxicity - Blinking exercises
28
contact lens papillary conjunctivis aetiology
- Mainly caused by soft contact lens wear and is a bilateral condition - The front surface of the lens caused mechanical irritation and immune response - Appear as localised swellings (papillae) on the tarsal conjunctiva – usually superior
29
contact lens papillary conjunctivis sympotoms
Asymptomatic in early stages In moderate/advanced:- Increased lens awareness or intolerance Increased mucus causes: drying of lens surface, deposits, fluctuating vision Itching/fb sensation
30
contact lens papillary conjunctivis signs
- Enlarged papillae – raised cobblestone appearance with blood vessel core - Roughness appearance of tarsal conj - Palpebral redness - Tissue oedema
31
contact lens papillary conjunctivis management
- Cease CL wear until resolved if moderate/severe - Reduce wear time - More frequent lens replacement - RGPs – better tear exchange and less mechanical irritation - Pharmacological therapy with optichrom (2%)
32
limbal hyperaemia aetiology
- More common in hydrogels - Short term manifestation of hypoxia - Inflammation due to tight lens or mechanical irritation from lens - Allergic reactions
33
limbal hyoperaemia symptoms
usually assymptomatic, mild discomfort may be felt
34
limbal hyperaemia signs
- Engorged BVs at limbus - May be localised or full coverage
35
limbal hyperaemia management
- Cease CL wear till resolution - Fit lens with higher Dk/t - Optimise lens fit – flatten lens - Remove allergen - Change care system
36
Nerovascularisation aetiology
- Uncommon nowadays due to improved lens materials - New vessels grow at a deep stromal level in response to corneal stress caused by hypoxia, limbal compression, tissue damage, acute infection and solution toxicity - Hypoxia causes stromal oedema and softening which releases vaso-stimulatory agents within growth of new vessels - If growth of new vessels is allowed to continue and encroach within the pupil area, vision may be reduced as surrounding tissue is changed
37
neovascularisation sympotoms
- Asymptomatic - Neovasc can accompany a painful anterior segment disease
38
nervascularisation signs
- Early signs are vessel spikes - Branching capillaries from limbal arcade - Anterior or deep vessels - Ghost vessels can remain as blood is drained from the new vessels
39
neovascularisation management
- Increase dk/t to as high as possible - Reduce wearing time - Patient advice and follow up - Change in care system if caused by solution toxicity
40
punctate staining aetiology
- Mechanical, exposure, metabolic, solution induced, allergic, infections
41
punctate staining symptoms
- Asymptomatic if less than grade 3 - May induce CL intolerance - Reduce WT - Dryness, itching and lacrimation
42
puncate staining signs
- SPK - Staining may be intense or diffuse - Bulbar conjunctival hyperaemia
43
puncatate staining management
- If grade 2 or less remove lenses for 24 hours - If grade 3 or more – lubrication, material, wearing schedule
44
smile staining aetiology
- Inferior epithelial arcuate lesion - Localised disruption of the corneal surface due to desiccation - Worse in thin and high water content lenses - Lens hydration leads to elimination of post lens tear film and ultimately epithelial desiccation - May be caused by sleeping with eyes slightly open
45
smile staining signs
- Desiccated area stains with NaFl - Punctate staining in inferior quadrant - Staining may coalesce - Stained areas are isolated from the limbus - Area of staining may be small, to almost semi-circular
46
smile staining symptoms
- Most asymptomatic - May include: dryness, itchiness, lens awareness
47
smile staining manaegment
- Determine cause - Increase centre thickness of lens - Lower water content lens – SiHi? - Alter lens design - Ask px about sleeping with eyes slightly open
48
seal staining aetiology
- Superior epithelial arcuate lesion - More common in higher modulus lenses - Mechanical – sheer forces from higher modulus lens on cornea - May also be caused by hypoxia, dehydration and physiology
49
seal staining symptoms
- Typically asymptomatic - Some may report irritation, discomfort, scratchiness
50
seal staining signs
- Split-like arcuate lesion - Parallel to limbus - 1-3mm in inside the limbus - 10 and 2 o’clock location - 0.5mm wide and 2.5mm long
51
seal staining management
- Remove lenses until healed, 2-4 days - Ocular lubricants to relieve symptoms - If problem occurs refit may be needed - If hypoxia is cause – lens with higher dk/t - If mechanical the cause – lens with lower modulus - Sign that px isn’t suitable for EW
52
endothelial folds atiology
- Hypoxia causes corneal oedema leading to bulking of corneal layers - The limbus constrains lateral expansion so swelling is directed posteriorly - Minimum of 8% swelling is required to produce folds
53
endothelian folds symptoms
- Mild discomfort - Hazy vision
54
endothelial folds signs
- Long straight dark lines seen in the endothelium or bulking in the posterior stroma - More than 4 folds indicates 10% oedema - Number of folds increases with increasing oedema
55
endothelial folds management
- Significant increase in dk/t needed - Short wear time - Switch to dailies for maximum oxygen transmissibility
56
contact lens peripheral ulcer aetiology
- Mainly unilateral and more common in EW - Considered to be an inflammatory response of the peripheral cornea - Corneal scrapes are culture-negative, so no causative organism is found - Due to interaction between the lens and epithelial surfaces - Scarring due to post inflammatory cicatrisation
57
contact lens peripheral ulcer symptoms
- Mild pain, may be described as FB - Photophobia - Decreased corneal sensitivity
58
contact lens peripheral ulcer signs
- Small single circular focal infiltrate with halo or diffuse infiltration, usually less than 1-2mm in diameter - The infiltrate is white with demarcated edges - Usually peripheral and located in the anterior stroma - The overlying epithelium is breached and rapidly takes up NaFl - May be focal or general redness - Lacrimation
59
contact lens peripheral ulcer management
- Immediately discontinue lens wear - Monitor carefully for first 24 hours - Prophylaxis - Chloramphenicol for 1-3 days - Ulcer will resolve with scarring
60
CLARE aetiology
- Acute inflammatory response usually occurring with soft EW CLs upon waking - Most common in first 3 months of lens wear - There may be lens binding overnight, causing entrapment of debris/deposits - Gram-negative bacteria - Sensitivity to lens care products - Debilitated GH i.e. upper respiratory tract infection
61
clare symptoms
- Painful eye upon waking - Photophobia - Lacrimation - Ocular irritation
62
clare signs
- Gross unilateral hyperaemia of the bulbar conjunctiva and limbus - Diffuse infiltrates (2-3mm from limbus), or focal zone of infiltrates - Minimal or no staining - Profuse lacrimation
63
clare management
- Temporary discontinue lens wear - Regular lens replacement, possibly no EW (if repeats) - Palliative therapy – saline rinse and lubrication - Low toxicity lens care products
64
infilterative keratitis aetiology
descrete collection of inflammatory cells
65
infilterative keratisis signs
- Peripheral to mid-peripheral - Mild or moderate diffuse infiltration or small focal infiltrate(s) - Located in the sup-epithelial or anterior stroma - Slight-moderate staining - Moderate limbal redness - No AC reaction or mild
66
infilterative keratitis symptoms
- Red, watery eye - Mild FB sensation - Mild photophobia
67
infilterative keratitis management
- Dictated by signs/symptoms, cause, risk of infection - If staining – discontinue, monitor, prophylaxis with antibiotic - Resolution before lens wear - Infiltrates will take around 2-3 weeks to clear - Advise against EW, warn about recurrence, switch to dailies if recurrence
68
microbial keratitis aetiology
- Rare but most serious CL complication - More common in extended wear due to CLs being worn when eyes are closed - Bacterial adherence especially aeruginosa - May also be viral, fungal, protozoa
69
microbial keratirts symptoms
- Mild irritation to severe pain - Photophobia - Reduced corneal sensitivity - Redness - Excessive tears/discharge
70
microbial keratitris signs
epithelial defects ulceration uveitis lid oedema
71
microbial keratatis management
- Cease CL and emergency referral - Culture/swabs of eye, lens case, solution - Treatment dictated by causal organism - Consider if lens wear is a future option
72
Polymegathism
- Structural damage to endothelial cells caused by long term hypoxia - Signs include differing cell sizes in endothelium - No real symptoms but px may develop sudden CL intolerance - Management – fit with higher dk/t lens - Prognosis not great – endothelial cells never heal and long term it can lead to endothelial decompensation
73
Striae
- Often seen in diabetics, older patients, keratoconics - Caused by hypoxia – lactic acid accumulation in the cornea causing an osmotic shift in stroma and corneal oedema - Patient is usually asymptomatic - White vertical lines are seen in the posterior stroma - Manage with dailies or increase dk/t

contact lens studies (16 decks)

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