SCL Complications Flashcards
Physical causes of complications
CL
- fit
- condition
- design
Blinking
- completeness
- lid Tonus
Causes of Visual complication
- current Rx
- presbyopia
- binocular vision
Wearer related causes
- non compliance
- failure to attend
Physiological causes
- Dk
- water content
- environment
- blinking
Pathological causes
- microorganisms
- condition of case
- chemical
- immunological issues
- environment
- existing pathology
Steps to prevent complications
- Px selection
- Px education
- lens selection
- aftercare and intervention
What are epithelial microcysts, and what are the risk factors, signs and management
- 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
Corneal vascularisation aetiology and management
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
What are infiltrates, aetiology and appearance
- 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
Infiltrative keratitis, signs and management
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
Asymptomatic infiltrative keratitis
- infiltration of the cornea with no symptoms
- small infiltrates
- peripheral
- similar management to IK
Corneal staining - general punctate, symptoms and management
Symptoms
- FB sensation
- irritation/grittiness
- excessive lacrimation
- reduced CL wear time
Management
- rewetting drops
- refit.
- reduce wear time
- treat underlying conditions
Epithelial abrasion/erosion
- 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
-
Contact lens induced papillary conjunctivitis (CLIPC)
Giant papillary conjunctivitis
Usually from SCLs
Aetiology
- front surface deposits
- immune response
- mechanical irritation
- drying of CL surface
CLIPC Symptoms and signs
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
CLIPC management
- modify CL wear
- pharmacological therapy
- Px education
- optimise CL care
- more frequent replacement
CL wrinkling, symptoms and management
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
Corneal staining - smile, signs/symptoms and management
- 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
Superior epithelial arcuate lesion SEAL
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
CL peripheral ulcer CLPU
- 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
Contact lens acute red eye aetiology
- EW
- gram -VE bacteria
- cl binding overnight
- sensitivity to cl care products
- trapped debris
- debilitated general health
- some seasonal variation
Contact lens acute red eye signs and symptoms
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
Contact lens acute red eye management
- temporary cease CL wear
- complete resolution of infiltrates
- optimise CL fitting
- regular CL replacement
- restart with DW
- change cl type
CL associates Superior limbal keratoconjunctivitis SLK
Aetiology
- solution preservative sensitivity
- cl deposits
- vision slightly
- mild discharge
Symptoms
- increased cl awareness
- mild discharge
- burning
- itchiness
- photophobia
- vision slightly affected
CL - associated SLK , signs and management
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
What is microbial keratitis aetiology
- caused by CLs
- EW increases risk
- bacterial
Microbial keratitis signs and symptoms
Signs
- severe
- discharge
- ulcer
- central or paracentral
- lid oedema
- hypopyon
- ac reaction
Symptoms
- irritation
- pain
- tearing and discharge
- redness
Marginal Keratitis management
- cease cl wear
- cultures/swabs
- change CL modality
Acanthamoeba keratitis
- protozoan
- pain and lacrimation
- ring defect
- blurred vision
- photophobia
- diagnosis
- pseudodendrite appearance
- corneal haze
- sight threatening
