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OPT506 > L20 - CL complications > Flashcards

L20 - CL complications Flashcards

1
Q

Lens discomfort - CL complication

A

Corneal erosions and abrasions
SEALs
Superior limbus keratitis

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2
Q

Ocular dryness - CL complication

A

SMILE stain

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3
Q

Lens care - CL complication

A

Solutions Induced Corneal Staining (SICS)

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4
Q

RGP related complications

A

3 and 9 o’clock staining

Foreign body track

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5
Q

CL complication Aetiologies

A 
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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6
Q

CL complications physical factors

A

CL fit, surface properties, condition, shape.

Blinking completeness, lid tonus

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7
Q

CL complications visual factors

A 
Accuracy of Rx 
Reproducibility / optical quality 
Binocular vision complication 
Incipient presbyopia 
Distance vs near (toric)
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8
Q

CL complications physiological factors

A

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

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9
Q

CL complications pathological factors

A 
CL condition
Micro organisms 
Immunological issues 
Chemical 
Environmental 
Pre existing ocular pathology
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10
Q

CL complications wearer related

A

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

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11
Q

CL complications - prevention

A 
Patient selection
CL selection 
Px education (preventative measures, signs, symptoms, actions) 
After care and appropriate interventions
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12
Q

CL complications - management + treatment

A

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

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13
Q

CLD (CL Related Discomfort)

A

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

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14
Q

CLD prevalence

A

With contemporary CLS, 50% of existing wearers get CLD

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15
Q

Impact of CLD on CL wear

A

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

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16
Q

Causes of SCL drop outs

A 
Discomfort 
Dryness 
Red eye 
Too expensive 
Handing issues 
Ran out CLs
CL maintenance
Eye infection 
Poor vision 
Allergy
Pregnancy 
Practitioner recommendation 
Laser surgery
17
Q

CLD signs + symptoms

A 
Commonly, none. 
Mild-moderate bulbar/palpebral conjunctival hyperaemia 
Corneal staining
Reduce comfortable wear time 
Dryness 
Tired of gritty eyes 
Relief on CL removal
18
Q

CLD management + treatment

A 
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
19
Q

CL acute discomfort possible causes

A 
Cl defect 
Surface quality or defect 
Edge shape or thickness 
Cl fit 
Foreign body 
Ocular surface damage 
Infection/ inflammation 
Toxicity
20
Q

Epithetical erosions

A

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

21
Q

Epithelial erosion signs/ symptoms

A 
FB sensations 
Pain on CL removal 
Sometimes asymptomatic 
Corneal staining 
Photophobia 
Epiphoria 
Limbal/bulbar hyperaemia
22
Q

Epithelial erosion prevalence

A

2% of all visits

23
Q

Epithelial erosion management

A

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

24
Q

Corneal abrasions/ erosions - signs and symptoms

A 
Dense localised staining 
Bulbar redness
Lacrimation 
Stromal infiltrates possible 
Mild to severe pain 
Photophobia
CL bandage effect may mask symptoms
25
Q

Aetiology of corneal abrasion/ erosions

A

Mechanical aetiology
Fingernails/ fingers
Trapped FB
CL defect

26
Q

Management of corneal abrasion

A 
Prevent secondary infection
Prophylactic antibiotics 
Monitor patient closely 
If infiltrates detected treat as MK until proved otherwise 
Avoid corticosteroids 
Bandage CL
27
Q

SEAL (Superior Epithelial Arcuate Lesion) - alternate names

A 
Epithelial splitting / splits 
SCL ar hate keratopathy (SLAK) 
Superior arcuate keratopathy
SCL Induced superior arcuate keratopathy
Tight lens syndrome
28
Q

SEAL prevalence

A

1.8-10%

29
Q

SEAL signs and symptoms

A 
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
30
Q

SEAL management

A

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

31
Q

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

A 
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
32
Q

CL associated superior limb if kerato-conjunctivitis - management

A 
Distinguish from SLK Theodore 
Discontinue CL wear 
Monitor recovery 
Lubricant 
Change CL design or fit 
Fit GP CLs 
Steroid therapy
33
Q

Smile staining

A

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

34
Q

Solution induced corneal staining - CL lens type most common cause

A

FDA group II hydrogels

SiHy materials when used with preserved care systems

35
Q

Solution induced corneal staining - management

A

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

36
Q

Solution induced corneal staining - signs and symptoms

A

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

37
Q

3 and 9 o’clock staining prevalence

A

Seen in up to 80% GPCL wearers

Significant in 15%

38
Q

3 and 9 o’clock staining signs and symptoms

A 
Slight discomfort 
Dryness 
Staining at 3 and 9 o’clock or 4 and 8 
Limbal locations 
Triangular patterns 
Inter palpebral conjunctival hyperaemia
39
Q

3 and 9 o’clock staining management

A

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)

OPT506 (16 decks)

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