Corneal Effects Of Cl Wear Flashcards
What’s atopy
Hay fever, eczema, allergy
What’s keratoconus
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.
How do u have a healthy eye. Or is it an healthy eye. I was never good with English
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
How do u wash ur hands properly? What a lol question. Obvs under the tap
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
Stuff not to do. You should know all this. And as a contact lens wearer- not actually do any of these
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
Why Px don’t listen to you
They don't understand Laziness Not compliant Unaware of consequences No problem so far....... Think it won't happen to them
What does the health belief model include ?
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
How would u improve ur communication
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
Every aftercare visit. What should u do
Inspect their case. Ask them to remove cl. Watch. And ask them to show u their cleaning regime.
What are risk factors for cl complications
Not washing hands Dirty cases Smokers Overnight wear Hyperopia Young Male Purchase online
What are the epithelial conditions that can occur due to contact lens complications
@Staining
@Microcyts- indication of reduction of 02 to the eye. Therefore use a SiH lens
Tell me stuff about fluorecine
1882
Stains loss of corneal integrity due to damaged cells, intercellular space due to dimple veiling and gaps on the epithelial surface
What are the sx of staining
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
What’s the Aetiology of staining
Mechanical Exposure Metabolic Toxic Allergic Infectious
Management if u see staining is :
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
Microcysts. What are they. What do they look like.
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
What are the stromal conditions that can occur which is seen on staining
Odeama
Neovasculirisation
Infiltrative keratitis
What’s oedema or edema if u think ur from America. Signs and Sx?
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.
Why does one get odema
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
How would u manage odema
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
Talk about corneal infiltrates
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
What’s Infiltrative keratitis
It’s symptomatic. Feels like a FB. Photophobia. Lacrimation. Lens intolerance.
CLPU
Inflammatory reaction of cornea. Focal excavation of the epithelium, infiltration and necrosis of anterior stroma. Bowmans layer is intact.
Microbial keratitis
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
Bacterial keratitis
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
