L20 - CL complications Flashcards
Lens discomfort - CL complication
Corneal erosions and abrasions
SEALs
Superior limbus keratitis
Ocular dryness - CL complication
SMILE stain
Lens care - CL complication
Solutions Induced Corneal Staining (SICS)
RGP related complications
3 and 9 o’clock staining
Foreign body track
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
CL complications physical factors
CL fit, surface properties, condition, shape.
Blinking completeness, lid tonus
CL complications visual factors
Accuracy of Rx Reproducibility / optical quality Binocular vision complication Incipient presbyopia Distance vs near (toric)
CL complications physiological factors
Dk/t
Water content (and factors affecting)
Blinking (frequency and completeness)
Environment
CL complications pathological factors
CL condition Micro organisms Immunological issues Chemical Environmental Pre existing ocular pathology
CL complications wearer related
Non compliance (misunderstanding, ignorance, carelessness)
Swapped CLs
Poor personal hygiene
Failure to attend after care visits
CL complications - prevention
Patient selection CL selection Px education (preventative measures, signs, symptoms, actions) After care and appropriate interventions
CL complications - management + treatment
Changes to the lens
Change to the case
Therapeutic and non therapeutic
Px education
CLD (CL Related Discomfort)
Condition characterised by episodic or persistent adverse ocular sensations related to CL wear
CLD prevalence
With contemporary CLS, 50% of existing wearers get CLD
Impact of CLD on CL wear
Overall wear time decreased
Quality-of-life - decreased wear time
Economic - has to purchase remedies, increased practice visits
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)
