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Contact Lens > SCL Complications > Flashcards

SCL Complications Flashcards

1
Q

Physical causes of complications

A

CL
- fit
- condition
- design

Blinking
- completeness
- lid Tonus

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2
Q

Causes of Visual complication

A
  • current Rx
  • presbyopia
  • binocular vision
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3
Q

Wearer related causes

A
  • non compliance
  • failure to attend
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4
Q

Physiological causes

A
  • Dk
  • water content
  • environment
  • blinking
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5
Q

Pathological causes

A
  • microorganisms
  • condition of case
  • chemical
  • immunological issues
  • environment
  • existing pathology
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6
Q

Steps to prevent complications

A
  • Px selection
  • Px education
  • lens selection
  • aftercare and intervention
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7
Q

What are epithelial microcysts, and what are the risk factors, signs and management

A
  • Related to Dk/t and wear modality
  • delayed onset - 2/3 months
  • common in EW
  • low cyst count regarded acceptable

Risk factors
- corneal dystrophy
- anterior eye infection
- chronic hypoxia
- ant eye infection

Signs
- small round dots
- vary in number
- usually asymptomatic
- reversed illumination
- only seen when breaking out of epithelium with flourascein

Management
- monitoring
- reduced CL wear time
- 3 month recovery
- cease EW
- increase CL Dk/t
- change to RGP

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8
Q

Corneal vascularisation aetiology and management

A

Aetiology
- hypoxia
- corneal oedema
- epithelial injury
- infection

Management
- removal of stimulus
- increase corneal O2 supply
- early intervention vital to prevent new vessels
- ghost vessels remain unless early intervention
- close monitoring is cl wear resumed

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9
Q

What are infiltrates, aetiology and appearance

A
  • epithelial/subepithelial/stromal
  • discrete collections of inflammatory cells
  • outerlying epithelium is intact
  • maybe sterile or infected

Aetiology
- bacterial presence
- poor hygiene
- tight CL
- hypersensitivity
- CL deposits
- hypoxia
- mechanical trauma

Appearance
- may be focal/arcuate/diffuse
- hazy, greyish-white
- tiny and circular to a woolly appearance
- epithelial/subepithelial/stromal

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10
Q

Infiltrative keratitis, signs and management

A

Signs/symptoms
- asymptomatic to painful
- CLs can mask problems
- foreign body sensation
- photophobia
- periphery to midperiphery
- anterior stroma
- no oedema
- no AC reaction can be bilateral
- small infiltrates
- slight staining
- moderate limbal redness

Management
- CL wear stops
- monitoring
- antibiotics/artificial tears
- Px education
- refit with SiHy and dailies
- resolution necessary before CL resumption

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11
Q

Asymptomatic infiltrative keratitis

A
  • infiltration of the cornea with no symptoms
  • small infiltrates
  • peripheral
  • similar management to IK
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12
Q

Corneal staining - general punctate, symptoms and management

A

Symptoms
- FB sensation
- irritation/grittiness
- excessive lacrimation
- reduced CL wear time

Management
- rewetting drops
- refit.
- reduce wear time
- treat underlying conditions

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13
Q

Epithelial abrasion/erosion

A
  • mechanical aetiology
  • fingernails
  • CL defect
  • trapped FB
  • significant abrasion causes disorganised epithelium

Signs
- mild/severe pain
- photophobia
- lacrimation
- bulbar redness
- dense localised staining
- stromal infiltrates

Management
- check for FB
- treat as MK
- prophylactic antibiotics
- monitor Px
- avoid corticosteroids
-

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14
Q

Contact lens induced papillary conjunctivitis (CLIPC)

A

Giant papillary conjunctivitis
Usually from SCLs

Aetiology
- front surface deposits
- immune response
- mechanical irritation
- drying of CL surface

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15
Q

CLIPC Symptoms and signs

A

Symptoms
- early asymptomatic
- increased lens movement
- increased CL awareness
- CL intolerance
- increased mucus effects drying
- itching

Signs
- enlarged papillae
- palp hyperaemia
- ptosis if chronic
- roughened appearance
- tissue oedema

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16
Q

CLIPC management

A
  • modify CL wear
  • pharmacological therapy
  • Px education
  • optimise CL care
  • more frequent replacement
17
Q

CL wrinkling, symptoms and management

A

Aetiology
- minus or plus BVP
- low water material
- lid forces

Symptoms
- reduced vision
- quick recovery
- rapid onset

Management
- change CL design
- thicker design
- SiHy CLs
- increase water content
- consider more rigid material
- GP lenses

18
Q

Corneal staining - smile, signs/symptoms and management

A
  • inferior corneal staining
  • pattern similar to smiling face

Symptoms
- most asymptomatic
- dryness
- itchiness
- CL awareness
- grittiness

Signs
- punctate staining inferiorly
- staining may coalesce
- lighter staining inferiorly
- staining isolated from limbus
- lighter staining inferiorly

Management
- increase cl centre thickness tc
- reduced water content

19
Q

Superior epithelial arcuate lesion SEAL

A

Symptoms
- dryness
- itchiness
- grittiness
- CL awareness

Signs
- 1-3mm inside limbus
- unilateral
- irregular edges
- little/no injection or inflammation

Management
- stop CLs immediately
- risk of neovascularisation

20
Q

CL peripheral ulcer CLPU

A
  • ulceration of epithelium with stromal inflammation
  • corneal scrapes negative
  • usually peripheral

Aetiology
- bacterial toxins
- staphylococcus SP
- interaction of CL and epithelial surfaces
- seasonal factor may apply

Signs
- small circular focal infiltrate
- usually peripheral
- overlying epithelium breached
- Haloe of diffuse infiltration
- anterior stroma
- redness tearing

Management
- stop CL wear
- rapid healing
- monitor carefully

21
Q

Contact lens acute red eye aetiology

A
  • EW
  • gram -VE bacteria
  • cl binding overnight
  • sensitivity to cl care products
  • trapped debris
  • debilitated general health
  • some seasonal variation
22
Q

Contact lens acute red eye signs and symptoms

A

Symptoms
- Px woken by pain
- photophobia
- lacrimation
- irritation

Signs
- moderate/severe pain
- 360 degree redness
- diffuse infiltrates
- focal zones of infiltrates
- minimal or no staining
- lacrimation

23
Q

Contact lens acute red eye management

A
  • temporary cease CL wear
  • complete resolution of infiltrates
  • optimise CL fitting
  • regular CL replacement
  • restart with DW
  • change cl type
24
Q

CL associates Superior limbal keratoconjunctivitis SLK

A

Aetiology
- solution preservative sensitivity
- cl deposits
- vision slightly
- mild discharge

Symptoms
- increased cl awareness
- mild discharge
- burning
- itchiness
- photophobia
- vision slightly affected

25
Q

CL - associated SLK , signs and management

A

Signs
- bilateral
- apron of redundant folds of bulbar conjunctiva
- infiltrates
- cornea and conj staining
- superior bulbar and limbal hyperaemia
- conj chemosis
- sub epithelial haze
- stains remain after cl cessation

Management
- cease cl wear
- GP lenses
- lubrication
- change CLs
- steroid therapy

26
Q

What is microbial keratitis aetiology

A
  • caused by CLs
  • EW increases risk
  • bacterial
27
Q

Microbial keratitis signs and symptoms

A

Signs
- severe
- discharge
- ulcer
- central or paracentral
- lid oedema
- hypopyon
- ac reaction

Symptoms
- irritation
- pain
- tearing and discharge
- redness

28
Q

Marginal Keratitis management

A
  • cease cl wear
  • cultures/swabs
  • change CL modality
29
Q

Acanthamoeba keratitis

A
  • protozoan
  • pain and lacrimation
  • ring defect
  • blurred vision
  • photophobia
  • diagnosis
  • pseudodendrite appearance
  • corneal haze
  • sight threatening

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