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Soft contact lens complications Flashcards

1
Q

how can we classify cl complications?

A

through aetiology or origin (mechanical) or by ocular structure effected

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2
Q

state 7 classifications of soft cl complications

A
  1. Metabolic influences (eg hypoxia)
  2. chemical influences(eg different ph with solution)
  3. toxic reactions (reactions with preservatives)
  4. allergic reaction (eg due to care regime or hypersenstivity to deposits)
  5. mechanical influences (breakages/modulus)
  6. tear deficiency (dehydration of lens)
  7. infection (eg bacterial)
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3
Q

what is a significant property of the cornea and how does it receive its nutrients?

A

cornea is avascular- nutrients supplied by aq humour and tears

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4
Q

state some corneal complications with soft lenses?

A

endothelial blebs,
microcysts,
oedema,
epithelial wrinkling,
staining,
neovascularisation,
endothelial bedewing,

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5
Q

how common is staining in a.) cl wear and b.) non cl wear

A

Common in up to 60% of contact lens wearers
Occurs in non-CL wearers (35%)

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6
Q

is staining asymptomatic?

A

can be asymptomatic

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7
Q

what are the 4 things to assess with corneal staining

A

Type, Location, Extent, Depth

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8
Q

what is three of describing CL staining pattern ?

A
  1. Puncate
  2. coalesced
  3. Confluent
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9
Q

what examples the locations of corneal staining

A

Location: e.g. central, peripheral, 3 o’clock to 4 o’clock

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10
Q

what are the two ‘extents’ to corneal staining

A

diffuse or localised

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11
Q

what are the depths of corneal staining

A

epithelial/superficial or stromal

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12
Q

what is SMILE staining?

A

located inferiorly, associated with dryness (eg dry environments) and incomplete blinks

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13
Q

how do we manage SMILE staining?

A

dry eye drops (preservative free), treat underlying MGD/bleph if present,modify environment, change lens type, blinking, 20/20/20, find underlying cause first

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14
Q

What can we do if SMILE staining is related to MGD?

A

we can re-review the px, to address the MGD

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15
Q

what is seen in mechanical corneal staining?

A

foreign body tracks

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16
Q

what can cause mechanical corneal staining

A

ABRASION - e.g. something caught under lens

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17
Q

how do we manage mechanical corneal staining?

A
  • removal of lenses
  • resume use once condition resolved,
  • re-review px,
  • lubrication (Eye drops etc),
  • cl re-fit esp if tight
    need to advise about hygiene ect, which to dailys if wearing monthlies
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18
Q

what does SEAL stand for?

A

superior epithelial arcuate lesion

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19
Q

what is SEAL normally associated with?

A

first generation siHy lenses

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20
Q

how do we manage SEAL

A
  • removal of lenses,
  • review px in 1 week,
  • refit with lower modulus lens,
  • consider rgp lenses : although this has a higher modulus, it is smaller.
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21
Q

how can we generally manage scl complications? general principles

A
  • remove lenses,
  • educate px on blinking eye drops,
  • what to do in emergency (Seek medical attention),
  • lubricating drops,
  • prophylactic antibiotics,
  • refer if severe staining (eg stromal),
  • find underlying cause
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22
Q

causes of microcysts

A

hypoxia

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23
Q

what are microcysts and do they show reversed or unreversed illumination?

A

superficial epithelial vesicles, Show reversed illumination (not fluid filled)

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24
Q

where are vacuoles usually found?

A

Usually in mid-peripheral cornea

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25
what can cause vacuoles?
chronic hypoxia
26
do vacuoles show reversed or unreversed illumination and why?
unREVERSED- as they are fluid filled
27
what is the average percentage of oedema we experience when sleeping?
4%
28
do daily or extended wear lenses cause more swelling
extended wear
29
what are the 3 different stages of oedema?
striae Folds Haze
30
what is the management for oedema?
remove lenses, manage wear time, change lenses
31
what is vascularisation?
normal vascular capillaries within cornea and limbus region-'enroachment 0.2mm'- more common superiorly due to lack of O2
32
What is neovascularisation?
Formation of new blood vessels in areas which were previously avascular
33
what is vasoproliferation?
Increase in no. of vessels
34
what are the 3 theories as to why neovascularisation can occur?
Metabolic theory Vasogenenic homeostasis model Neural theory
35
what is the metabolic theory for neovasc?
* hypoxia causes production of VEGF * lactic acid (hypoxia and or tight fit lens), * stromal softening (chronic oedema) - reduces physical barrier for vessel to grow * oedema (Excess fluid)
36
what is the vasogenic theory for neovasc?
local vasostimulatory factors= corneal vascularisation- creates conc that new vessels grow on, followed by inflam + leuokocytes- these may produce vasostimulatory factors
37
what is the neural theory for neovasc?
corneal nerves can play in vessel growth- cl wear associated with corneal nerves/sensitivity
38
what does neovasc appear as?
superficial or deep stromal
39
what is superficial neovasc and what is a complication?
vessels can leak an extra vascular lipid-like fluid and can cross line of sight
40
what is deep stromal neovasc?
- occurs at all levels of stroma - numerous tortuous branches - pattern of vessels may reflect breakdown in stromal tissue - loss of vision occurs IF crosses line of sight
41
how can we manage neovasc?
cease cl wear monitor recovery of px, -can leave ghost vessels possible refit to siHy lenses greater movement on fitting earlier recall
42
characteristics of epithelial wrinkling?
rare cl complication, painful, VA usually affected (basically tight fit causes epithelial to wrinkle up)
43
how do we manage epithelial wrinkling?
stop cl wear, can resolve within 6 hrs but can take upto 1 wk
44
is px symptomatic with endothelial bedewing and why?
px can be symptomatic- redness, irritation, stinging, lens intolerance DUE TO inflam cells on endothelium
45
Does enothelial bedewing show reversed or unreversed illumination?
reversed-like epithelial microcysts
46
how can we manage endothelial bedewing?
rule out other possible things- PDS (pigment dispersion syndrome) or uveitis, then refit with dailies
47
what are endothelial blebs?
black non-reflecting 'holes', 'transient change' in corneal endothelium
48
when can endothelial blebs be seen?
in 10 mins of insertion- peak at 30 mins
49
how can we observe endothelial blebs? (technique)
specular mag technique- need high mag
50
what is aetiology of endothelial blebs?
‘acidic shift’ CO2/lactic acid
51
name some CL ocular conditions in relation to eyelid
lid wiper epitheliopathy(LWE), incomplete blinking, MGD
52
What is CL induced Ptosis?
more common in rgp wearers, can be due to abnormal insertion and removal- stretch levator and weaken muscle, CAUSED BY weak levator aponeurosis or abnormal force
53
name disorders of the conjunctiva?
hyperaemia, lid wiper epitheliopathy (LWE) lid parallel conjunctival folds (LIPCOF) staining papillary conjunctivits (CLPC) conjunctival epithelial flap
54
state some palpebral changes?
hyperaemia, papillae, follicles and concretions
55
what is the difference of follicles and papillae
follicles - not CL related, sign of viral infection papillae - have central blood vessel , can be sign of GPC
56
what do concretions look like?
pale yellow accumulations beneath the palpebral conjunctival epithelium
57
what symptoms do you get with concretions?
foreign body sensation
58
what are signs of CL associated papillary conjunctivitis?
Papillae Hyperaemia Mucus discharge- Lens deposition-protein- can affect comfort Excessive movement- rgps
59
what is the first sign of inflammation?
hyperaemia
60
what are symptoms of cl associated papillary conjunctivitis?
blurred vision (lens deposits, mucus) itching FB sensation
61
what are causes of cl associated papillary conjunctivits?
allergic, mechanical, hypersensitiy, stiffer material SCL, sensitivty to solutions or preservatives, MGD
62
how do we manage cl associated papillary conjunctivits (short-term)?
remove source- eg if mechanical or protein deposits- cease cl wear or change solution, allow to resolve- can take a few months, preservative free lubricants
63
how do we manage cl associated papillary conjunctivits (long-term)?
Improve lens care regime Daily disposables Alter lens design or material- refit after grade 1, Manage any lid margin disease
64
what are disorders associated with limbus?
redness and Superior limbic keratoconjunctivitis
65
what is limbal hyperaemia?
series of blood vessels within the limbus
66
how can we treat limbal hyperaemia?
Record-use grading scale Cease lens wear Refit with high Dk lens/SiH Reduce WT Alter lens fit Review care regime
67
what is the aetiology of limbal hyperaemia?
Hypoxia Infection / Inflammation Trauma Solution toxicity/ hypersensitivity Lens deposits Mechanical- answer if px wears sihy- as can’t by hypoxia
68
characteristics of superior limbic keratoconjunctivitis?
Involves corneal epithelium, stroma, limbus, bulbar and tarsal conjunctiva, associated with cl solution toxicity Hypoxia, thought to be an aggravating factor
69
what can sectoral conjunctival hyperamia be associated with?
likely to be specific cause eg infilitrate,
70
what can interpalpebral conjunctival hyperamia be associated with?
chronic dryness and RGP wear Can be an allergic and/or mechanical cause
71
what can bulbar hyperaemia be associated with?
Common with soft CL wear, but also a sign associated with many other serious eye conditions
72
what are the 3 types of conj hyperaemia?
sectorial, interpalpebral and bulbar
73
how do we manage conj hyperaemia?
Identify and address cause Refit- change lens design Refit-change lens material e.g. different modulus or Dk Refit- more frequent replacement Review care regime Ocular lubricants Consider environmental factors
74
what is a lens indentation?
Lens indentation (furrow staining) Pressure from superior lid
75
what is a conjunctival epithelial flap?
loose conj tissue in area of lens indentation- can be superior or inferior, assoiciated with sihy cl wear, – cause superficial layers of conjunctival cells to break down - found in GP wearers-esp if poor fit and going across inferior limbus
76
How do we manage conj epithelial flap?
1. cease cl wear 2. lower modulus lens 3. reduce overnight wear
77
What can diffuse punctate staining covering the limbus, cornea and conjunctiva be a sign of?
toxicity
78
What is the managment of a toxcity reaction?
1. stay out of lenses until resolved 2. review in 2-3 days 3. address cause (e.g. change solution)
79
Where is conjunctival epithelial flaps found in the most?
GP lens - poor fit and going across the inferior limbus
80
what do concretions look like?
pale yellow accumulations beneath the palpebral conjunctival epithelium
81
management of conj epithelial flap?
cease lens wear lower modulus reduce overnight wear
82
what deposits are these?
protein
83
what material are protein deposits attracted to?
hydrogel
84
when you have protein deposits what other signs do you see?
papillary conjunctivitis
85
management of protein deposits?
1. review care routine 2. increase lens replacement frequency 3. change material
86
what deposits are these?
Lipids
87
what materials are lipid deposits attracted to?
group 2 and SiHy lenses
88
what symptoms does the px get with lipid deposits?
smeary vision colour fringes toric lens may destabilise
89
management of lipid deposits
1. review care routine 2. increase lens replacement frequency 3. change material 4. treat any MGD
90
what deposits are these?
Fungal
91
why do you get fungal deposits on lenses?
contamination of lens by fungus
92
what are fungal deposits associated with?
intermittent wearers and long-term lens storage poor hygiene
93
management of Fingal deposits
1. need to replace lens 2. review hygiene 3. care regimen 4. switch to dailies
94
what are jelly bumps?
- focal gelatinous lumps - mucous lipid protein and calcium build up
94
What deposits are these?
Jelly bumps
95
what symptoms does the patient present with if they have jelly bumps?
no/moderate discomfort
96
management of jelly bumps?
1. review care routine 2. increase lens replacement frequency 3. change material to low water content lens
97
what are mucin balls?
- focal accumulation of mucus and lipids under the lens which causes an indentation in the epithelium
98
what material are mucin balls associated with?
extended wear of SiHy lenses
99
what symptoms do patients present with if they have mucin balls?
asymptomatic
100
what deposits are these?
Mucin balls
101
Management of mucin balls?
1. monitor 2. review lens material or modality if possible 3. ocular lubricants

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