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Contact Lenses > Soft contact lens complications > Flashcards

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
Q

what can cause vacuoles?

A

chronic hypoxia

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26
Q

do vacuoles show reversed or unreversed illumination and why?

A

unREVERSED- as they are fluid filled

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27
Q

what is the average percentage of oedema we experience when sleeping?

A

4%

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28
Q

do daily or extended wear lenses cause more swelling

A

extended wear

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29
Q

what are the 3 different stages of oedema?

A

striae
Folds
Haze

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30
Q

what is the management for oedema?

A

remove lenses, manage wear time, change lenses

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31
Q

what is vascularisation?

A

normal vascular capillaries within cornea and limbus region-‘enroachment 0.2mm’- more common superiorly due to lack of O2

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32
Q

What is neovascularisation?

A

Formation of new blood vessels in areas which were previously avascular

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33
Q

what is vasoproliferation?

A

Increase in no. of vessels

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34
Q

what are the 3 theories as to why neovascularisation can occur?

A

Metabolic theory
Vasogenenic homeostasis model
Neural theory

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35
Q

what is the metabolic theory for neovasc?

A
  • 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)
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36
Q

what is the vasogenic theory for neovasc?

A

local vasostimulatory factors= corneal vascularisation- creates conc that new vessels grow on, followed by inflam + leuokocytes- these may produce vasostimulatory factors

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37
Q

what is the neural theory for neovasc?

A

corneal nerves can play in vessel growth- cl wear associated with corneal nerves/sensitivity

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38
Q

what does neovasc appear as?

A

superficial or deep stromal

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39
Q

what is superficial neovasc and what is a complication?

A

vessels can leak an extra vascular lipid-like fluid and can cross line of sight

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40
Q

what is deep stromal neovasc?

A
  • 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
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41
Q

how can we manage neovasc?

A

cease cl wear
monitor recovery of px, -can leave ghost vessels
possible refit to siHy lenses
greater movement on fitting
earlier recall

42
Q

characteristics of epithelial wrinkling?

A

rare cl complication,
painful,
VA usually affected (basically tight fit causes epithelial to wrinkle up)

43
Q

how do we manage epithelial wrinkling?

A

stop cl wear, can resolve within 6 hrs but can take upto 1 wk

44
Q

is px symptomatic with endothelial bedewing and why?

A

px can be symptomatic- redness, irritation, stinging, lens intolerance DUE TO inflam cells on endothelium

45
Q

Does enothelial bedewing show reversed or unreversed illumination?

A

reversed-like epithelial microcysts

46
Q

how can we manage endothelial bedewing?

A

rule out other possible things- PDS (pigment dispersion syndrome) or uveitis, then refit with dailies

47
Q

what are endothelial blebs?

A

black non-reflecting ‘holes’, ‘transient change’ in corneal endothelium

48
Q

when can endothelial blebs be seen?

A

in 10 mins of insertion- peak at 30 mins

49
Q

how can we observe endothelial blebs? (technique)

A

specular mag technique- need high mag

50
Q

what is aetiology of endothelial blebs?

A

‘acidic shift’ CO2/lactic acid

51
Q

name some CL ocular conditions in relation to eyelid

A

lid wiper epitheliopathy(LWE),
incomplete blinking,
MGD

52
Q

What is CL induced Ptosis?

A

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
Q

name disorders of the conjunctiva?

A

hyperaemia,
lid wiper epitheliopathy (LWE)
lid parallel conjunctival folds (LIPCOF)
staining
papillary conjunctivits (CLPC)
conjunctival epithelial flap

54
Q

state some palpebral changes?

A

hyperaemia, papillae, follicles and concretions

55
Q

what is the difference of follicles and papillae

A

follicles - not CL related, sign of viral infection
papillae - have central blood vessel , can be sign of GPC

56
Q

what do concretions look like?

A

pale yellow accumulations beneath the palpebral conjunctival epithelium

57
Q

what symptoms do you get with concretions?

A

foreign body sensation

58
Q

what are signs of CL associated papillary conjunctivitis?

A

Papillae
Hyperaemia
Mucus discharge-
Lens deposition-protein- can affect comfort
Excessive movement- rgps

59
Q

what is the first sign of inflammation?

A

hyperaemia

60
Q

what are symptoms of cl associated papillary conjunctivitis?

A

blurred vision (lens deposits, mucus)
itching
FB sensation

61
Q

what are causes of cl associated papillary conjunctivits?

A

allergic, mechanical, hypersensitiy, stiffer material SCL, sensitivty to solutions or preservatives, MGD

62
Q

how do we manage cl associated papillary conjunctivits (short-term)?

A

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
Q

how do we manage cl associated papillary conjunctivits (long-term)?

A

Improve lens care regime
Daily disposables
Alter lens design or material- refit after grade 1, Manage any lid margin disease

64
Q

what are disorders associated with limbus?

A

redness and Superior limbic keratoconjunctivitis

65
Q

what is limbal hyperaemia?

A

series of blood vessels within the limbus

66
Q

how can we treat limbal hyperaemia?

A

Record-use grading scale
Cease lens wear
Refit with high Dk lens/SiH
Reduce WT
Alter lens fit
Review care regime

67
Q

what is the aetiology of limbal hyperaemia?

A

Hypoxia
Infection / Inflammation
Trauma
Solution toxicity/ hypersensitivity
Lens deposits
Mechanical- answer if px wears sihy- as can’t by hypoxia

68
Q

characteristics of superior limbic keratoconjunctivitis?

A

Involves corneal epithelium, stroma, limbus, bulbar and tarsal conjunctiva,

associated with cl solution toxicity

Hypoxia, thought to be an aggravating factor

69
Q

what can sectoral conjunctival hyperamia be associated with?

A

likely to be specific cause eg infilitrate,

70
Q

what can interpalpebral conjunctival hyperamia be associated with?

A

chronic dryness and RGP wear
Can be an allergic and/or mechanical cause

71
Q

what can bulbar hyperaemia be associated with?

A

Common with soft CL wear, but also a sign associated with many other serious eye conditions

72
Q

what are the 3 types of conj hyperaemia?

A

sectorial, interpalpebral and bulbar

73
Q

how do we manage conj hyperaemia?

A

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
Q

what is a lens indentation?

A

Lens indentation (furrow staining)
Pressure from superior lid

75
Q

what is a conjunctival epithelial flap?

A

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
Q

How do we manage conj epithelial flap?

A
  1. cease cl wear
  2. lower modulus lens
  3. reduce overnight wear
77
Q

What can diffuse punctate staining covering the limbus, cornea and conjunctiva be a sign of?

A

toxicity

78
Q

What is the managment of a toxcity reaction?

A
  1. stay out of lenses until resolved
  2. review in 2-3 days
  3. address cause (e.g. change solution)
79
Q

Where is conjunctival epithelial flaps found in the most?

A

GP lens - poor fit and going across the inferior limbus

80
Q

what do concretions look like?

A

pale yellow accumulations beneath the palpebral conjunctival epithelium

81
Q

management of conj epithelial flap?

A

cease lens wear
lower modulus
reduce overnight wear

82
Q

what deposits are these?

A

protein

83
Q

what material are protein deposits attracted to?

A

hydrogel

84
Q

when you have protein deposits what other signs do you see?

A

papillary conjunctivitis

85
Q

management of protein deposits?

A
  1. review care routine
  2. increase lens replacement frequency
  3. change material
86
Q

what deposits are these?

A

Lipids

87
Q

what materials are lipid deposits attracted to?

A

group 2 and SiHy lenses

88
Q

what symptoms does the px get with lipid deposits?

A

smeary vision
colour fringes
toric lens may destabilise

89
Q

management of lipid deposits

A
  1. review care routine
  2. increase lens replacement frequency
  3. change material
  4. treat any MGD
90
Q

what deposits are these?

A

Fungal

91
Q

why do you get fungal deposits on lenses?

A

contamination of lens by fungus

92
Q

what are fungal deposits associated with?

A

intermittent wearers and long-term lens storage
poor hygiene

93
Q

management of Fingal deposits

A
  1. need to replace lens
  2. review hygiene
  3. care regimen
  4. switch to dailies
94
Q

what are jelly bumps?

A
  • focal gelatinous lumps
  • mucous lipid protein and calcium build up
94
Q

What deposits are these?

A

Jelly bumps

95
Q

what symptoms does the patient present with if they have jelly bumps?

A

no/moderate discomfort

96
Q

management of jelly bumps?

A
  1. review care routine
  2. increase lens replacement frequency
  3. change material to low water content lens
97
Q

what are mucin balls?

A
  • focal accumulation of mucus and lipids under the lens which causes an indentation in the epithelium
98
Q

what material are mucin balls associated with?

A

extended wear of SiHy lenses

99
Q

what symptoms do patients present with if they have mucin balls?

A

asymptomatic

100
Q

what deposits are these?

A

Mucin balls

101
Q

Management of mucin balls?

A
  1. monitor
  2. review lens material or modality if possible
  3. ocular lubricants

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