Corneal Effects Of Cl Wear Flashcards

0
Q

What’s atopy

A

Hay fever, eczema, allergy

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1
Q

What’s keratoconus

A

Irregular shaped cornea
Irregular astigmatism
Worsening va
Corneal thinning
Forward protusion
Associated with atopy, heredity, Down’s syndrome, marfans and RP
Signs include- munsons sign, vogts stress line, prominent corneal nerves, harmosiderrin ring.

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2
Q

How do u have a healthy eye. Or is it an healthy eye. I was never good with English

A
No smoking- deposits on cl, less hygiene these people have, AMD risk 
Exercising -no obesity
No alcohol
Good nutrition- link with green veg
Less uv exposure- wear sunglasses 
Also protection from chemicals and burns 
Good hygiene 
Regular sight tests
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3
Q

How do u wash ur hands properly? What a lol question. Obvs under the tap

A

Remove jewellery
Wet hands
Apply liquid soap
Rub hands for 15 seconds. Cover all surfaces
Rinse hands
Dry with disposable towel
Close tap with towel or elbow or something other than ur hand

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4
Q

Stuff not to do. You should know all this. And as a contact lens wearer- not actually do any of these

A
Not washing and drying hands before lens touching
Swimming without goggles
Licking lenses
Reinserting lens after it's dropped on the floor
Contaminating lenses with hair spray/ makeup
Inappropriate eye drops?
Sharing ur cl
Going to sleep in ur cl
Wearing them when ill
Extending wt
Not changing cl
Wearing lens inside out
Wearing lenses after expiration date
Switching lens type without Optom advice 
Wearing lenses when eyes don't feel good
Rinsing cl with tap water 
Eliminating the rub procedure 
Using incorrect sols
Not storing lenses in case
Re using or topping solutions
Not covering cl with solution
Not letting them soak for appropriate time
Not replacing top properly 
Not cleaning case
Sharing the lens case
Using old solutions 
Using a diff solution which Optom did not advise 
Not attending ac appts
Not having backup specs 
Not seeking medical advice if anything happens
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5
Q

Why Px don’t listen to you

A
They don't understand
Laziness
Not compliant 
Unaware of consequences
No problem so far.......
Think it won't happen to them
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6
Q

What does the health belief model include ?

A

Susceptibility- will it effect me?
Severity- yes then probs more scared
Benefits- can u prevent it. If I can’t, then why try
Barriers not to comply. If there’s lots. And it’s diff. Px not really bothered

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7
Q

How would u improve ur communication

A
Use appropriate language 
Be nice 
Have a good tone
Listen to them
Have open questions 
More dos than donts 
Be specific to ur Px 
Use memorable analogies
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8
Q

Every aftercare visit. What should u do

A

Inspect their case. Ask them to remove cl. Watch. And ask them to show u their cleaning regime.

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9
Q

What are risk factors for cl complications

A
Not washing hands
Dirty cases
Smokers 
Overnight wear
Hyperopia
Young
Male 
Purchase online
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10
Q

What are the epithelial conditions that can occur due to contact lens complications

A

@Staining

@Microcyts- indication of reduction of 02 to the eye. Therefore use a SiH lens

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11
Q

Tell me stuff about fluorecine

A

1882
Stains loss of corneal integrity due to damaged cells, intercellular space due to dimple veiling and gaps on the epithelial surface

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12
Q

What are the sx of staining

A

Generally none. But can have some discomfort or FB sensation. May Ben have dryness. That’s why u give artificial tears if u see staining

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13
Q

What’s the Aetiology of staining

A
Mechanical
Exposure
Metabolic
Toxic
Allergic
Infectious
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14
Q

Management if u see staining is :

A

Cease cl wear as slow prognosis with. Reduce mechanical trauma if that’s cause. Remove toxin if that’s cause. Wait for infection to go away?
Usually good prognosis. Give artificial tears for comfort

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15
Q

Microcysts. What are they. What do they look like.

A
1976
Usually due to low O2
Generally occurs as soon as u wear cl
Also caused by acidosis 
Can be seen in non cl wearers 
Lower prevalence in DD
On Central and para central cornea. 
Uniform and spherical in shape 
See with revered illumination 
Superficial punctuate staining increases with this
Vision usually unaffected
And Px asymptomatic 
Slow rate of onset 

You manage this condition by fitting a higher dk/t lens. Even a DD. Reduce WT. Change from a soft lens to a RGP. The prognosis is strong on this one

16
Q

What are the stromal conditions that can occur which is seen on staining

A

Odeama
Neovasculirisation
Infiltrative keratitis

17
Q

What’s oedema or edema if u think ur from America. Signs and Sx?

A

1880s
Increase in tissue fluid. Sort of like swelling.
Related to hypoxia.
Thickness is usually only measured for research. But u can tell if
Striae- fine wispy white vertically oriented lines. Usually odeama if more than 5%. They become greyer and more in quantity as more odeama. They do not cause a loss of vision.
You can also get folds. Depressed grooves and ridges of endothelium. This is if u have 8% odema. They increase as the odeama does.
Can also get haze. When odema is like 15%. Loss of corneal transparency. And a degradation of vision.

18
Q

Why does one get odema

A

Endothelium pump disrupted
Striae u get bc fluid separation of collagen fibrils in posterior stroma
Folds- physical buckling of posterior stromal
Haze- gross separation of fibrils, disrupting the regularity
Odeama leads to stromal thinning
Hypoxic therefore anaerobic respiration and formation of lactate.
This osmotic imbalance - balanced now by influx of water- pump overload

19
Q

How would u manage odema

A

Increase O2 to cornea. By a higher dk/t. Also reduce WT.
Holdern and mertz criteria is for Dw- 24 and EW- 87

V good prognosis. And the speed of recovery effects the health of cornea

20
Q

Talk about corneal infiltrates

A

It’s inflammatory cells invading cornea. Usually asymptomatic. Maybe mild photophobia. The signs are fine punctual staining with mild limbal/ bulbar redness. The management u have is discontinue lens wear. And if ur wearing EW change to DW.

ALSO BE SURE IT IS NOT INFILTRATIVE KERATITIS

21
Q

What’s Infiltrative keratitis

A

It’s symptomatic. Feels like a FB. Photophobia. Lacrimation. Lens intolerance.

22
Q

CLPU

A

Inflammatory reaction of cornea. Focal excavation of the epithelium, infiltration and necrosis of anterior stroma. Bowmans layer is intact.

23
Q

Microbial keratitis

A

Could be bacterial viral fungal or omeaba. Risk factors includ extended wear, swimming, poor hygiene and compliance, smoking and poor general health. U get severe rapid onset of pain. Photophobia. Epiphoria. HypereMia. Discharge. Lid swelling. And these all sx continue after lens removal. You also see AC activity. Immediately remove lense and start anti microbial treatment. As sight threatening

24
Q

Bacterial keratitis

A
Corneal abrasion 
Entropian 
Dry eye
Contact lens use
Long term steroid use

Staphylococcus and streptococcus cause oval yellow white sense infiltration
Psudononomas aeruginosa cause irregular shaped ulcer that progress rapidly