RGP complications

Question 1

3-9 o’clock staining

Answer 1

Aetiology:
- poor edge design
- thick edge
- edge clearance too large / too small
- TD too large / too small
- insufficient blinking
- irritation + dryness

Symptoms:
-can be asymptomatic

Signs:
- usually bilateral
- follows shape of lens
- bulbar redness
- nasal + temp punctate staining
- can coalesced over time
- can lead to neovas/ulceration/scarring

Management:
- refit with thinner edge design
- refit with SiHy
- refit with GP lens if over 2.00DC
- ocular lubricants
- blinking exercises
- may lead to reduce WT

Question 2

Vascularised limbal keratitis

Answer 2

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

Symptoms:
- possibly symptomatic
- increased redness
- increased discomfort
- possible pain
- photophobia + lacrimation

Signs:
- limbal mass with BVs
- appears opaque + elevated
- associated with conj staining

Management:
- cease CL wear
- consider refitting flatter lens
- ocular lubricants
-can be reversed
- monitor with regular a/c appointment

Question 3

Dellen

Answer 3

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

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

Symptoms:
- possibly asymptomatic
- can present with irritation + dryness

Signs:
- saucer like depression
- can pool with NaFl
- localised thinning of cornea
- possible 3-9 staining
- epithelium usually intact

Management:
- manage 3-9 staining
- rewetting drops
- blinking exercises
- cease CL wear
- reduce WT
- refit with SCL

Question 4

Dimple veil

Answer 4

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

Symptoms:
- usually none
- reduced vision if central + numerous

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

Question 5

FB track

Answer 5

• material trapped by CL > eyelashes, deposits

Symptoms:
-asymptomatic to sharp pain

Management:
- irrigation
- remove lens
- possible antibiotic

Question 6

Other corneal problems with RGPs

Answer 6

• corneal oedema
• vascularisation
• acanthomeoba keratitis

Question 7

RGP adherence

Answer 7

• common in EW
• caused by thinning of tear film + eyelid pressure

Symptoms:
-asymptomatic / FB sensation + blurred vision

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

Question 8

Lens warpage

Answer 8

Aetiology:
- heavy handling
- allowed to dry out
- thin lens
- pressed into lens case

Symptoms:
- reduced vision
- discomfort
- reduced WT

Management:
- px education
- replace lens
- increase lens thickness

Question 9

RGP induced Ptosis

Answer 9

Mechanical interaction with lids causing inflammation + swelling - gravity pulls lids down

Management:
- cease CL wear
- regular a/c
- refit with SCL
- reduce CL thickness
- make sure to rule out other causes