L20 - CL complications Flashcards by Poppy Pearn

Lens discomfort - CL complication

Corneal erosions and abrasions
SEALs
Superior limbus keratitis

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Ocular dryness - CL complication

SMILE stain

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Lens care - CL complication

Solutions Induced Corneal Staining (SICS)

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RGP related complications

3 and 9 o’clock staining

Foreign body track

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CL complication Aetiologies

Physical (including CL fit) 
CL BVP
CL dehydration 
Surface deposits / poor wettability
Altered blinking 
Hypoxia
Pre existing disease 
Chemicals 
Microbiological 
Immunological 
Patient non - compliance 
Idiopathic

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CL complications physical factors

CL fit, surface properties, condition, shape.

Blinking completeness, lid tonus

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CL complications visual factors

Accuracy of Rx 
Reproducibility / optical quality 
Binocular vision complication 
Incipient presbyopia 
Distance vs near (toric)

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CL complications physiological factors

Dk/t
Water content (and factors affecting)
Blinking (frequency and completeness)
Environment

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CL complications pathological factors

CL condition
Micro organisms 
Immunological issues 
Chemical 
Environmental 
Pre existing ocular pathology

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CL complications wearer related

Non compliance (misunderstanding, ignorance, carelessness)
Swapped CLs
Poor personal hygiene
Failure to attend after care visits

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CL complications - prevention

Patient selection
CL selection 
Px education (preventative measures, signs, symptoms, actions) 
After care and appropriate interventions

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CL complications - management + treatment

Changes to the lens
Change to the case
Therapeutic and non therapeutic
Px education

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CLD (CL Related Discomfort)

Condition characterised by episodic or persistent adverse ocular sensations related to CL wear

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CLD prevalence

With contemporary CLS, 50% of existing wearers get CLD

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Impact of CLD on CL wear

Overall wear time decreased
Quality-of-life - decreased wear time
Economic - has to purchase remedies, increased practice visits

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Causes of SCL drop outs

Discomfort 
Dryness 
Red eye 
Too expensive 
Handing issues 
Ran out CLs
CL maintenance
Eye infection 
Poor vision 
Allergy
Pregnancy 
Practitioner recommendation 
Laser surgery

CLD signs + symptoms

Commonly, none. 
Mild-moderate bulbar/palpebral conjunctival hyperaemia 
Corneal staining
Reduce comfortable wear time 
Dryness 
Tired of gritty eyes 
Relief on CL removal

CLD management + treatment

Eliminate factor causing discomfort 
Detailed H+S (systemic disease) 
Identify and remedy cause (eg dry eye)
CL care system 
Switch wearing modality 
Enhance tear film
Punctual occlusion 
Lacrimal inserts 
Increase fatty acid intake in diet (omega-3)
Avoid challenging environments

CL acute discomfort possible causes

Cl defect 
Surface quality or defect 
Edge shape or thickness 
Cl fit 
Foreign body 
Ocular surface damage 
Infection/ inflammation 
Toxicity

Epithetical erosions

Full thickness detachment of epithelium in localised and well circumscribed region of the cornea that can occur with or without CL wear

Epithelial erosion signs/ symptoms

FB sensations 
Pain on CL removal 
Sometimes asymptomatic 
Corneal staining 
Photophobia 
Epiphoria 
Limbal/bulbar hyperaemia

Epithelial erosion prevalence

2% of all visits

Epithelial erosion management

Remove CL
Cease wear
Prevent recurrence (ocular lubricants)
Prophylactic antibiotics

Corneal abrasions/ erosions - signs and symptoms

Dense localised staining 
Bulbar redness
Lacrimation 
Stromal infiltrates possible 
Mild to severe pain 
Photophobia
CL bandage effect may mask symptoms

Aetiology of corneal abrasion/ erosions

Mechanical aetiology Fingernails/ fingers Trapped FB CL defect

Management of corneal abrasion

``` Prevent secondary infection Prophylactic antibiotics Monitor patient closely If infiltrates detected treat as MK until proved otherwise Avoid corticosteroids Bandage CL ```

SEAL (Superior Epithelial Arcuate Lesion) - alternate names

``` Epithelial splitting / splits SCL ar hate keratopathy (SLAK) Superior arcuate keratopathy SCL Induced superior arcuate keratopathy Tight lens syndrome ```

SEAL prevalence

1.8-10%

SEAL signs and symptoms

``` 1-3mm inside limbus Parallel to Linus Split like arcuate lesion 10 and 2o clock location 0.5mm wide, 2-5 mm long Discomfort/ dryness/ irritation/ burning Sometimes asymptomatic ```

SEAL management

Cease CL wear Risk of infections, scar and neovascularization Wait 3-7 days Continue with new / same CLs

CL associated superior limb if kerato-conjunctivitis - signs and symptoms

``` Usually bilateral Superior bulbar and limbal hyperaemia Conjunctival chemists Grey infiltrates Sun epithelial haze SCL wearers mainly Corneal and conjunctival staining Limbal hypertrophy Palpebral response Papillae / redness Signs remain after CL removal Burning Itching Photophobia Mild discharge Affected vision possible ```

CL associated superior limb if kerato-conjunctivitis - management

``` Distinguish from SLK Theodore Discontinue CL wear Monitor recovery Lubricant Change CL design or fit Fit GP CLs Steroid therapy ```

Smile staining

Inferior epithelial arcuate lesion Occurs from ocular dryness Remove lens and recovers within 24 hours May need ocular lubricant May need to change CL fit/ thicker material

Solution induced corneal staining - CL lens type most common cause

FDA group II hydrogels | SiHy materials when used with preserved care systems

Solution induced corneal staining - management

Solutions without added preservatives Rinse CL with saline prior to insertion Switch to DD lenses

Solution induced corneal staining - signs and symptoms

Usually asymptomatic Mild staining or burning Maximal staining usually 2hours after lens wesr Superficial punctate keratitis

3 and 9 o’clock staining prevalence

Seen in up to 80% GPCL wearers | Significant in 15%

3 and 9 o’clock staining signs and symptoms

``` Slight discomfort Dryness Staining at 3 and 9 o’clock or 4 and 8 Limbal locations Triangular patterns Inter palpebral conjunctival hyperaemia ```

3 and 9 o’clock staining management

Alter lens design: Improve centration (decrease CT/ increase TD) Edge clearance (if excessive decrease ET, if not increase ET to encourage lid attachment) Blinking instructions Improve lens wetting Increase lens movement (increase BOZR, decrease BOZD or TD)