RGP Complications Flashcards
Give examples of which complications overlap between soft CLs and RGPs?
- There are complications that present in both soft CLs & RGPs such as CLAPC & microbial keratitis
What are the signs, symptoms, and management of corneal staining - 3 & 9 (RGP complications)?
- Will be seen – not v rare
- Aetiology:
o Poor edge design
o Thick edge design
o Edge clearance too large or too small
o Total diameter too larger or too small
o Insufficient blinking - Symptoms:
o Can be asymptomatic
o Irritation/dryness
o Reduced wearing time
o Red eyes - Signs:
o Usually bilateral
o Follows shape of lens (inner edge normally curved)
o Nasal & temporal punctate staining
o Can coalesce over time
o Bulbar redness nasal & temporal
o Can lead to:
Neovascularisation of cornea
Ulceration
Scarring - Management:
o Refit with thinner edge design
o Refit with a GP toric lens if cornea is >2DC
o Refit with SiHy Soft CL
o Ocular lubricants
o Blinking exercises
o May need to ↓wearing time – always good idea to take break from CLs to get staining managed then can fix underlying problem
What are the symptoms, signs and management of vascularised limbal keratitis (RGP complications)?
- A sequel to chronic 3 and 9 o’clock staining
- EW a risk factor
- Large diameter lenses/steep fit/narrow edge lift – most likely in tight fitting lens
- Mechanical irritation
- Rare
- Symptoms:
o Can be asymptomatic in early stages
o Gradually ↑in discomfort – can be painful if advanced
o Photophobia (if cornea is affected) & lacrimation
o Increasing ocular redness (as severity increases) - Signs:
o Appears as a limbal mass with BVs – usually opaque & elevated
o Associated conjunctival staining
o This appears more elevated (vs an ulcer which would appear more stromal & deeper in the layers) - Management:
o This can be reversed
o Stop CL wear
o Consider refitting with smaller/flatter lens (once have resolution)
o Ocular lubricants
o Monitor with regular aftercare appts
What are the risks, signs, symptoms and management of Dellen (RGP complications)?
- Desiccation at periphery of cornea
- Due to dehydration of cornea which causes layers to compact together (causes thinning in this region & resulting in a dip)
- Risks:
o Thick edge on CLs
o Increased tear evaporation
o Pinguecula/pterygium
o Post-surgery - Symptoms:
o Can be asymptomatic
o Can present with irritation & dryness
o May be symptoms of associated conditions such as 3 & 9 o’clock staining & dry eye disease - Signs:
o Saucer-like depression
o Localised thinning of cornea
o Can pool with fluorescein (if put optical section on this, will see that the NaFl has not diffused through any of the layers of cornea)
o Epithelium usually intact
o Put thin beam on it – will not see the 3 layers of the cornea & layers will appear squashed - Management:
o Manage any associated 3 & 9 o’clock staining or dry eye disease
o Removing lens wear usually leads to resolution of depression in a few days, scarring may remain
o But need to solve underlying problem:
Re-wetting drops
Blinking exercises
Reduce wearing time
Refit with soft lenses (as does not seem to occur with soft CLs) – best option is a high Dk SiHy
Describe the signs, symptoms and management of corneal staining - dimple veil (RGP complications)?
- Gas bubbles trapped in tear film, break up into multiple small bubbles with pressure
- Leaves small pits/indents in epithelium – has not broken through the cells but will compress them
- ‘Pools’ with fluorescein (if put optical section on this, will see that the NaFl has not diffused through any of the layers of cornea)
- Caused by excessive corneal clearance/edge clearance so can be due to a steep or flat lens
o Can be seen centrally or peripherally - Symptoms:
o Asymptomatic (usually)
May have symptoms unrelated to dimple veil staining but due to fit of lens instead - V flat – variable vision as lens moves around
- V tight – may have dryness & redness
o Reduced vision if:
Central
Numerous
Large - Signs:
o Bubbles are the dark circles & the dimple veil staining are the green/blue circles - Management:
o Will resolve slowly if lenses removed
o Prevent by altering fit:
Reducing edge clearance (steepen) – bubbles occurring peripherally
Reducing central clearance (flatten) – reduce pooling in centre
Describe how you classify staining seen in CL wear?
- Type:
o Punctate
o Coalescent
o Patch
o Linear
o Arcuate - Depth:
o Superficial epithelial
o Deep epithelial
o Stromal diffusion - Location:
o By quadrant (superior, inferior, nasal, temporal) or central
o & using appropriate grading scale - Size:
o Use beam height & width to approximate this – v critical for monitoring healing
What are the symptoms and management of foreign body track (RGP complications)?
- More likely to happen in RGP – when material is trapped under lens
- Material trapped by CL
o Eyelashes
o Grit/sand
o Make up
o Back surface lens deposits – if lens is old or not being cleaned properly
o Lid margin debris/flakes of skin
o Damaged lens – chip/crack in lens
o Fingernail - Symptoms:
o Range from asymptomatic to sharp pain with associated lacrimation - Irrigation if still uncomfortable once lens removed
- Need to thoroughly examine eye including lid eversion
- Management:
o Remove lens for 24-48hours to allow for full healing
o Prophylactic antibiotic – if small stain & off axis & don’t suspect from any particularly risky material (like plant material) then would be tempted not to
Only if the FB has been particularly unclean or it is a v large area of compromised cornea
o Sunglasses/eye protection
o Replace damaged lens
o Conversation around I&R – if suspect something like fingernail – consider a reteach
Describe conjunctival staining (RGP complications)?
- Poor fitting:
o Excessive movement
o Decentration
o Large diameter – crossing over
o Edge defects – damage to edge of lens - Incomplete/poor blinking – dehydration – not getting redistribution of tear film
- Underlying dry eye disease
- Management:
o Improve CL fit
Steepen fit (usually caused by a flat fit)
o Lubrication during CL wear – re-wetting drops regularly
o Blinking exercises – look at them blinking on SL, are they an incomplete blinker?
o Refit – could switch them to soft CLs or different RGP that may be better for wettability
Describe corneal oedema (RGP complications)?
- Look at last semester notes for more info
- Less common than with Soft CLs due to the high Dk of RGPs (though some modern SCLs also have high Dk)
- Can be more subtle with RGPs
- Manage by stopping any EW and reducing wear time
- Maximise Dk
- Err on the flat side when fitting as tend to see this more when lens is tight – fitting with more movement allows for tear exchange
Describe corneal vascularisation (RGP complications)?
- Look at last semester notes for more info
- Due to inadequate oxygen supply or a decentred lens over limbus or a tight-fitting lens or dellen
- Manage by increasing Dk/t
- Optimise CL fit, ensuring adequate movement but with good centration
o Don’t want a lens so tight that it is not moving
o Don’t want a lens so loose that it is crossing limbus
What are the symptoms and management of RGP adherence (RGP complications)?
RGP being stuck
* Rare in DW but v common in EW
* Main cause is believed to be a thinning of tear film & eyelid pressure during sleep
* Can be asymptomatic when it is happening
* Symptoms include:
o FB sensation
o Blurred vision with & without the lens (as corneal shape may have been altered slightly)
o Dryness
* Management:
o Revert to DW
o Ocular lubricants in morning
o Do not remove lens until it is mobile
o Reduce TD – can increase movement of lens
Describe the symptoms and management of lens warpage (RGP complications)?
Shape of lens has been affected
‘Heavy handling’ e.g. cleaning between thumb & forefinger – best to clean lens in palm of hand
* Flat base on lens case
* Pressed into lens case
* Allowed to dry out – should store lens in solution
* Thin lens design is more vulnerable to lens warpage
* If everything else seems normal, eyeball healthy then this may be reason
* Symptoms:
o Reduced vision
o Discomfort
o Reduced WT
* Irregular mires on keratometer or focimeter lens
* No endpoint on refraction or a v odd result
* Altered fit & NaFl pattern
* Management:
o Re-educate px
o Replace lens
o Increase lens thickness
Describe ptosis (RGP complications)?
- Long term GP wear
- Upper lid rests in a lower-than-normal position
- Typically bilateral
- Can be accompanied by thickening & reddening of upper lid
- Possible causes:
o Mechanical interaction (lid riding over CL edge)
o Oedema of lid tissue & then gravity lowers it down
o Inflammation can result in temporally ptosis - Management:
o Make sure RGP lens fits
o Stop lens wear temporarily
o Refit with Soft CLs
o Reduce CL thickness – to try & stop so much lid-lens interaction
o Regular after-care
o Make sure to rule out other causes (that are not related to CLs e.g. 3rd nerve palsy (would be a more dramatic ptosis))
Describe acathamoeba keratitis in CL wear?
- Protozoan MK
- Acanthamoeba are found in tap water, increased risk with CL wear
- Clinical signs are disproportionate to symptoms – difficult to diagnose in early stages
- Px will report pain and possibly lacrimation, blurred vision, photophobia
- Signs are non-specific in the early stages
o Possibly infiltrates or a pseudodendrite appearance (similar to Herpes)
o A ring defect will appear in due course w/o tx (not seen in early stages) - Diagnosis often delayed
- Be aware of this in a CL wearer
- Rare
- Sight threatening – it is stubborn organism that is difficult to irradicate
- Must be treated by ophthalmology, corneal scraping required for diagnosis
