GP complications Flashcards
What should be part of a GP A/C app
Case hx: - dexterity of insertion/removal - wear time - 2+1 - max hrs - days/wk Comfort/vision cleaning/storage Qs/concerns
GP A/C SLE
White light:
- centration - with/w/o lids
- movement - blink/lateral gaze
- integrity - deposits/tears/scratches
Blue light:
- check pattern - consistent?
Health:
- lid eversion - papillae
Hyperaemia - esp limbal area
Cornea - central clouding?/other oedematous changes
Aetiology of 3/9 o’clock staining
Px factors:
- dry eye/poor tear film/poor wetting cl surface
Partial/reduced blinks
Inadequate mucin surfacing/resurfacing of cornea
Cl fit factors:
- excessive edge clearance/thickness
Cl size too small /poor centration/minimal movement
Ew>dw
Management of 3/9 o’clock staining
Px education Tear supplements Improve blinking/rate Improve cl fit Increase cl wettability Decrease surface deposits Modify wear time Temp cease cl wear/refit with SCLs
How to improve cl fit for 3/9 o’clock staining
Increase TD
Decrease edge clearance
Aspheric/blended back surface
Refit with mini sclerals?
Aetiology of dellen
Elevations - pinguecula/pterygium/thick edged GP CLs
Tear film evaporation - dry corneal surface/exposure
Post op effects - IOL , sub-conj injections, recti muscles surgery, glaucoma procedures, suture granuloma
Episcleritis/scleritis
Cocaine administration (medical)
Paralytic lagophthalmos
DELLEN management
Determine cause Ocular lubrication Temp cease cl wear DD SCLs - bandage cl monitor recovery If cont cl use needed - consider SCL /mini Sclerals
How to treat a FB
Remove cl
Remove/flush FB - using sterile saline/artificial tears
Check under lids
Managing a FB
Prophylactic antibiotics may be required
Eye protection
Px education - expect fbs ocassionally
Change cl design/care system
Cl adherence is a common consequence of ..
Overnight GP cl wear
Occurs on wakin
48% users experience it
What makes cl adherence worse
Flat fit
Aspheric design
Aetiology for cl adherence
Ew Thinned/viscosity of aq depleted PLTF Lid pressure Dehydration/contamination of PLTF Physical properties/topography of cornea
Cl factors leading to cl adherence
Flat fit Small edge lift Large TD Limited movement Lid pressure
Management for cl adherence
Px education - assess cl /morning Ocular lubricants Mobilise cl with lid pressure Never remove cl until mobile
Cl fit Decrease TD Fit with slight apical pooling Increase tear vol Revert to DW Switch from aspheric design
Aetiology for cl flexure
Central cl too thin Large BOZD/high minus BVP Lid force on blinking Corneal toricity Material Steep central fit Low lid position?
Cl flexure may lead to…
Changes in residual astigmatism
Varied vision
Changes in cl parameters
Managing cl flexure
Thicker cl More rigid material More o2 permeable material Decrease BOZD Fit BST/bitoric cl
Causes of cl warpage
Heavy handling - poorly instructed px - cleans between thumb/finger
Cl case issues - flat base, smooth walls, cl pressed into bottom of well, dry storage, allowed to dry out
Thin cl design
Managing cl warpage
Replace cl
Px re-education
Optimise cl design
Hands free cleaning
Causes of corneal shape changes
Mechanical effect due to poor cl/cornea fit
Corneal bearing
Pressure from upper lid
Ptosis and cls
Sign of long term GP cl wear
Very rare with SCLs
Possible adaptation? -to decrease cl movement
Reversible - expending on cause
Ptosis and cl management’
Temp cease cl wear Refit SCLs Optimise cl edge shape Decrease thickness Severe cases may need surgery
Surface crazing
Due to high silicone (siloxane) content (SA)
Material/manufacturing flaw
Interaction with cl care products
Individual anterior eye environments
Uncommon with modern materials FSAs
Papillae v follicles
Papillae is chronic response - allergy typ1/3
Follicles acute response -toxic reaction to chemicals/chlamydia not allergy/hypersensitivity related
Papillae seen in cl wear/Normals
Follicles not assoc with cls
Papillae superior palpebral conj near lateral canthus
Follicles inferior palpebral conj near lateral canthus
Papilllae have vascular tuft
Follicles avascular
