Lid/lashes complications and Papillary conjunctivitis Flashcards
What glands release the lipid portion of the tear film?
Glands of Zeis
Meibomian glands
What glands release the aqueous portion of the tear film?
Lacrimal glands
Glands of Krause and Wolfring
What releases the mucin portion of the tear film?
Goblet cells
Which glands release sweat?
Glands of Zeis
Glands of Moll
Which glands release the baseline tears?
Lacrimal glands
Gland of Krause and Wolfring
What is ectropian and how is it caused?
Lower lid turned out
Age or palsy causing lid laxity
What is entropian and how is it caused?
Lower lid turning inwards
Age related lid laxity
Retractor weakness
Congenital
Cicatrical (scarring)
Should you fit CLs if the px has ectropian?
Not if severe - if tears are spilling out and causing dryness, CLs could exacerbate
Should you fit CLs if the px has entropian?
Yes - could be therapeutic, protecting from lashes
What are the causes of ptosis?
Age
Neurogenic
Myogenic
Mechanical
CL induced (RGPs)
What is retraction/proptosis?
Very wide eyes!
Can you fit a px with ptosis with CLs?
Yes, but may struggle to get in and out depending on severity
What are the causes of proptosis?
Neurogenic
Congenital
Thyroid eye disease
What can happen to the cornea as a result of proptosis? How could this be remedied with CLs?
Very dry cornea due to lids not meeting.
Scleral lenses to keep the surface moist.
What is trichiasis?
Lashes turning in
What causes trichiasis? How can it be treated?
Blepharitis or herpes zoster
Epilation/electrolysis/cryotherapy
What is distichiasis?
Lashes growing in abnormal places
What are the causes of distichiasis? How can you treat it?
Congenital or acquired (from trauma or inflammation)
Treated by epilation/electrolysis/cryotherapy
What is poliosis? What’s it caused by?
Premature whitening of lashes
Caused by inflammation
What is madaronis? What’s it caused by?
Reduction in number of lashes or complete loss
Caused by chronic lid margin disease or skin disease - can also be self inflicted
What are the signs of a lice infestation?
Prescence of lice/nits
Brown/red at lash base
Erythema
Red conjunctiva
What are the symptoms of a lice infestation?
Burning
Itchiness
Crusts
Lid margin swelling
Non tol to CLs
How should you manage a lice infestation?
Remove any visible lice
Advise scrubs 2x daily to remove debris
Use ointment 2x daily to trap/kill lice
Advise STI treatment and to deep clean home environment
Treatment should be around 2 weeks
Should a px with a lice infestation be wearing CLs?
No - CLs can be a vector for corneal infection
Where do demodex folliculorum live?
Lash follicles
Where do demodex brevis live?
Gland of Zeis
What are the signs of a mite infestation?
Presence of demodex
Erythema
Madarosis
Conjunctival redness
Collarettes at lash base
MG blockage
What are the symptoms of a mite infestation?
Burning
Itchiness
Crustiness
Lid margin swelling
Lash loss
Non tol to CLs
Sxs worse in am/evening
In which groups is mite infestation more prevalent?
Diabetics
Older pxs
CL wearers
AIDS pxs
Long term corticosteroid users
How should you manage a mite infestation?
Remove crusting (local anaesthetic)
Lid scrub w/ tea tree oil shampoo x2 daily (TTO is toxic to ocular surface so care needed)
No oily cosmetics
Use ointment in eve to trap mites
Treat for around three weeks
What is a chalazion and what causes it?
Sterile inflammation of MG due to blockage of gland
What are the signs and symptoms of a chalazion?
Painless, firm, round bump in tarsal plate
How should you manage a chalazion?
Should resolve spontaneously
Hot compress and massage
If persistent - surgery or steroid injection or systemic tetracycline
Can a px with chalazion wear CLs?
Yes - if comfortable for px as sterile
If fitting - fit once resolved
What is an internal hordeolum?
Inflamed swelling within tarsal plate on palpebral conjunctiva
What is an internal hordeolum caused by?
Acute staphylococcus infection of MG
What are the symptoms of an internal hordeolum?
Tenderness
Swelling
Maybe discharge
How should you manage an internal hordeolum?
Manage the infection
If persistent - surgery
What is an external hordeolum?
AKA stye
Tender bump on outer lashline
What causes an external hordeolum?
Acute staphylococcus infection of lash follicle or gland of Zeis/moll
What are the symptoms of an external hordeolum?
Tenderness
Inflammation
Swelling of lid margin
How should you manage an external hordeolum?
Should resolve spontaneously (~7 days)
Hot compress
Topical/systemic antibiotics
Epilation of infected lash
Should a px with a hordeolum wear CLs?
No - increases risk of infection to cornea
Comfort will also be effected due to increased movement of CL on blinking
How should you manage a ‘lost’ CL?
Always assume still in eye
Use fluorescein to stain CL if soft
Evert lid and use pen torch or SL to look for CL
How long can it take for CLPC to develop?
Soft lenses: 2+ weeks
RGP: up to 14 months
What causes CLPC?
Non specific immune response due to hypersensitivity
Protein deposits on reusable CLs
Mechanical trauma
Individual susceptibility (eg MGD, eczema, asthma)
Where are you most likely to see papillae?
Central tarsal plate
Soft: zone 1/2
RGP: zone 3
What are the symptoms of CLPC?
Acute ocular discomfort
CL non tol
Itching
Mucous discharge
Lens movement
Increased deposits
Reduced VA and CS
What are the signs of CLPC?
Cobblestone appearance
Red
Rough
Conjunctival oedema
Mucous
Vessels at apex of papillae
Corneal staining, infiltrates and limbal redness
What’s a normal grade for CLPC?
0.5-1 EFRON
What’s the prevalence of CLPC?
RGPs: 2%
Soft: 6-12%
Overnight wear: 18%
DDs: 2%
What are some non pharmacological treatments for CLPC?
Cold compress
Stop CL wear
Improve hygiene
Increase lens replacement (eg change to dailies)
Decrease wear time
Optimise CL fit
Change to preservative free solution
When might pharmacological treatments be needed for CLPC?
If above grade 2
What pharmacological treatments are there for CLPC?
Topical mast cell stabiliser
Topical combined antihistamine
Topical steroid (IP only)
What’s the prognosis for CLPC?
2 weeks - 6 months to heal completely
Apices can scar
Px not to wear CLs until healed if severe
What can giant papillary conjunctivitis be caused by?
Elevated corneal structures
Ocular prosthesis
Nylon sutures
Sclera buckles
Blebs
(Not usually CL related)
What are some differences between CLPC and follicular conjunctivitis?
Follicular = viral, different sxs, not associated with CL wear, vessels visible on outside of follicle, usually in lower fornix
Papillae = allergic, vessels on apex of papillae
