RGP Complications

Question 1

3-9 o’clock staining aetiology

Answer 1

• poor edge designs
• thick edge design
• edge clearance too large or too small
• TD too large or too small
• insuffient blinking
• can be asymptomatic
• irritation and dryness
• reduced wear time

Question 2

3-9 signs

Answer 2

• usually bilateral
• follows shape o the lens
• bulbar redness
• nasal and temporal punctate staining
• can coalesce over time
• can lead to neovascularisation/ulceration/scarring

Question 3

3-9 management

Answer 3

• Refit with thinner edge design
• refit with SiHy
• refit with GP lens if over 2.00DC
• ocular lubricants
• blinking exercises
• may lead to reduced wear time

Question 4

What is vascularised limbal keratitis

Answer 4

• chronic 3-9 staining
• EW at risk
• mechanical irritation
• rare
• large. Diameter lenses

Question 5

Vascularised limbal keratitis signs and symptoms

Answer 5

Symptoms
- possibly asymptomatic
- increased redness
- increased discomfort
- possible pain
- photophobia and lacrimation

Signs
- limbal mass with blood vessels
- appears opaque and elevated
- associated with conj staining

Question 6

Vascularised limbal keratitis management

Answer 6

• stop CL wear
• consider refitting flatter lens
• ocular lubricants
• can be reversed
• monitor with regular aftercare appointments

Question 7

What are dellen, and its risk factors

Answer 7

• dissociation at peripheral cornea
• due to dehydration of cornea
• layers compact together

Risks
- thick lens edge
- increased tear evaporation
- pterygium/pinguecula
- post surgery

Question 8

Dellen signs and symptoms

Answer 8

Symptoms
- possibly asymptomatic
- possible 3-9 staining
- can present with irritation and dryness

Signs
- saucer like depression
- can pool with flouroscein
- localised thinning of cornea
- epithelium usually intact

Question 9

Dellen management

Answer 9

• manage 3-9 staining
• rewetting drops
• blinking exercises
• cease CL wear
• reduce wear time
• refit with soft lens

Question 10

What is a dimple veil, and its symptoms and management

Answer 10

• It is indentations in the epithelium caused by air bubbles trapped under lens
• pools with flouroscein
• caused by excessive corneal clearance

Symptoms
- usually none
- reduced vision if central and numerous

Management
- reduce CL wear
- prevent by altering fit, reduce edge lift and central clearance

Question 11

What is a foreign body track

Answer 11

Material trapped by CL
- eyelashes, deposits etc

Symptoms
- asymptomatic to sharp pain

Management
- irrigation
- remove lens
- possible antibiotic

Question 12

Other corneal problems with RGPs

Answer 12

Corneal oedema
Vascularisation
Acanthomeoba keratitis

Question 13

RGP adherence, symptoms and management

Answer 13

• common in EW
• caused by thinning of tear film and eyelid pressure
• can be asymptomatic or FB sensation and blurred vision

Management
- back to DW
- ocular lubricants
- lower total diameter
- do not remove lens until mobile

Question 14

What is lens warpage, and its symptoms and management

Answer 14

• heavy handling
• flat on lens case
• allowed to dry out
• thin lens
• pressed into lens case

Symptoms
- reduced vision
- discomfort
- reduced wear time

Management
- Px education
- replace lens
- increase lens thickness

Question 15

How can RGPs cause a ptosis, and what is the management

Answer 15

Mechanical interaction with lids causing inflammation and swelling, gravity pulls lids down

Management
- cease CL wear
- regular aftercare
- refit with SCLs
- make sure to rule out other causes
- reduced CL thickness