Lid/lashes complications and Papillary conjunctivitis Flashcards by Beth Wilkinson

What glands release the lipid portion of the tear film?

Glands of Zeis
Meibomian glands

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What glands release the aqueous portion of the tear film?

Lacrimal glands
Glands of Krause and Wolfring

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What releases the mucin portion of the tear film?

Goblet cells

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Which glands release sweat?

Glands of Zeis
Glands of Moll

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Which glands release the baseline tears?

Lacrimal glands
Gland of Krause and Wolfring

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What is ectropian and how is it caused?

Lower lid turned out
Age or palsy causing lid laxity

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What is entropian and how is it caused?

Lower lid turning inwards
Age related lid laxity
Retractor weakness
Congenital
Cicatrical (scarring)

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Should you fit CLs if the px has ectropian?

Not if severe - if tears are spilling out and causing dryness, CLs could exacerbate

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Should you fit CLs if the px has entropian?

Yes - could be therapeutic, protecting from lashes

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What are the causes of ptosis?

Age
Neurogenic
Myogenic
Mechanical
CL induced (RGPs)

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What is retraction/proptosis?

Very wide eyes!

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Can you fit a px with ptosis with CLs?

Yes, but may struggle to get in and out depending on severity

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What are the causes of proptosis?

Neurogenic
Congenital
Thyroid eye disease

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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.

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What is trichiasis?

Lashes turning in

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What causes trichiasis? How can it be treated?

Blepharitis or herpes zoster
Epilation/electrolysis/cryotherapy

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What is distichiasis?

Lashes growing in abnormal places

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What are the causes of distichiasis? How can you treat it?

Congenital or acquired (from trauma or inflammation)
Treated by epilation/electrolysis/cryotherapy

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What is poliosis? What’s it caused by?

Premature whitening of lashes
Caused by inflammation

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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

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What are the signs of a lice infestation?

Prescence of lice/nits
Brown/red at lash base
Erythema
Red conjunctiva

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What are the symptoms of a lice infestation?

Burning
Itchiness
Crusts
Lid margin swelling
Non tol to CLs

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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