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Contact lenses year 3 > Soft contact lens complications Pt 1 > Flashcards

Soft contact lens complications Pt 1 Flashcards

1
Q

which 2 ways can contact lens complications be classified as

A
  • according to their aetiology/origin
    or
  • according to the ocular structure affected e.g. cornea, lid, conjunctiva etc
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2
Q

list the 7 categories SCLs complications can be classified into

A
  • Metabolic influences
  • Chemical influences
  • Toxic reaction
  • Allergic reaction
  • Mechanical influences
  • Tear deficiency
  • Infection
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3
Q

give 3 examples of metabolic influences of SCL complications

A
  • Hypoxia
  • Hypercapnia
  • Changes in osmolarity
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4
Q

give an example of chemical influences of SCL complications

A

Solution with a different pH

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5
Q

give an example of a toxic reaction of SCL complication

A

reaction to preservative

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6
Q

give 2 examples of allergic reactions to SCLs

A
  • Hypersensitivity to care regime

- CL deposition

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7
Q

give 2 examples of mechanical influences of SCL complications

A
  • Lens edge

- Lens break/damage

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8
Q

give an example of a tear deficiency SCL complication

A

dehydration

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9
Q

give 2 examples of infections of SCLs

A
  • Bacterial

- Fungal

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10
Q

list 4 complications of the eyelid

A
  • lid wiper epitheliopathy
  • blinking abnormalities: causing SMILE staining from incomplete blink
  • MGD
  • ptosis
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11
Q

in which type of SCL wearing patients if ptosis more common in and by how much

A

Soft CL wear approx. 5x more common in young px who developed unexplained
acquired ptosis

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12
Q

Soft CL wear has been reported as the most common ______ _________ for ________ in patients under ___ years old

A

Soft CL wear has been reported as the most common risk factor for ptosis in patients under 35 years old

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13
Q

what is the cause of ptosis induced by SCLs

A

likely to be abnormal force on eyelids during I+R or/and intrinsically weak elevator aponeurosis

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14
Q

what are the 2 SCL complications of the limbus

A
  • redness

- Superior limbic keratoconjunctivitis

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15
Q

what is limbal redness

A

Limbal vascular arcadesseries

of blood vessels within the limbus

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16
Q

what is common in most CL wearers

A

mild limbal hyperaemia

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17
Q

what was the outcome of a study that compared the extent of limbal and bulbar redness in subjects wearing EW low Dk SCLs in one eye and no lens in the other eye over a period of 5 years

A

that there was not much difference between these patients in bulbar redness, but more of a difference between the eyes in limbal redness for the patients wearing SCLs, therefore redness around the limbus is more apparent than the bulbar for SCL users

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18
Q

which type of SCL induces less limbal redness that standard low Dk hydrogel lenses

A

silicone hydrogel lenses = eyes appear whiter with these lenses

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19
Q

list the 7 possibles aetiologies of limbal redness

A
  • Hypoxia
  • Infection
  • Inflammation
  • Trauma
  • Solution toxicity/hypersensitivity
  • Lens deposits
  • Mechanical
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20
Q

why is limbus redness one of the first signs in SCL wearers

A

because theres lots of blood vessels around the limbus

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21
Q

list the 6 management steps for limbal redness

A
  • Record-use grading scale (and write what scale used)
  • Cease lens wear
  • Refit with high Dk lens/SiH
  • Reduce wear time
  • Alter lens fit
  • Review care regime
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22
Q

what is another name for superior limbic keratoconjunctivitis

A

Contact lens induced superior limbic keratoconjunctivitis (CLSLK)

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23
Q

which 5 structures of the eye does Contact lens induced

superior limbic keratoconjunctivitis (CLSLK) involve

A
  • corneal epithelium
  • corneal stroma
  • limbus
  • bulbar conjunctiva
  • tarsal conjunctiva
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24
Q

what can be seen in the slit lamp with someone who has Contact lens induced
superior limbic keratoconjunctivitis (CLSLK)

A

superior limbic redness and corneal staining

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25
Q

Contact lens induced

superior limbic keratoconjunctivitis (CLSLK) is an inflammatory reaction of…..

A

the superior cornea

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26
Q

what is Contact lens induced

superior limbic keratoconjunctivitis (CLSLK) associated with

A

CL solutions containing thimerosal (toxic substance)

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27
Q

when has there been a reduced prevalence of Contact lens induced
superior limbic keratoconjunctivitis (CLSLK)

A

since the use of thimerosal has declined

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28
Q

as well as thimerosal, what else can Contact lens induced

superior limbic keratoconjunctivitis (CLSLK) also occur as a response to

A

hypoxia or allergy

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29
Q

what are the 4 management options for a patient with Contact lens induced superior limbic keratoconjunctivitis (CLSLK)

A 
- Solutions-without added
preservatives (hydrogen peroxide)
- Or switch to a different
multipurpose solution
- Change to daily disposables (if due to allergy as it cuts out solutions and deposits)
- Reduce wear time (if due to hypoxia)
30
Q

list 7 conjunctival complications related to SCLs

A
  • redness
  • lid wiper epitheliopathy
  • conjunctival epithelial flap
  • palpebral conjunctival changes
  • papillary conjunctivitis
  • staining
  • lid parallel conjunctival folds (LIPCOF)
31
Q

list 4 possible palpebral changes

A
  • hyperaemia
  • papillae
  • follicles
  • concretions
32
Q

what is hyperaemia of the palpebra the first sign of

A

inflammation

33
Q

what are papillae

A

Raised areas on the palpebral conjunctiva

34
Q

what do papillae have that follicles dont have

A

a central blood vessel

35
Q

what appearance of papillae is indicative of giant papillary conjunctivitis or vernal keratoconjunctivitis

A

Presence of papillae on the upper tarsal conjunctiva >1.0mm diameter

36
Q

what are follicles

A

Focal accumulations of white blood cells within the palpebral conjunctiva without a central blood vessel

37
Q

what are follicles associated with

A

viral infections

38
Q

what is follicles not related to

A

contact lenses

39
Q

what is the difference in location of papillae and follicles

A
  • papillae are found under upper eyelid only

- follicles are found on the lower lid mainly and sometimes under the upper eyelid

40
Q

what are concretions

A

Pale yellow accumulations of inorganic type material beneath palpebral conjunctival epithelium

41
Q

what symptom may concretions cause

A

FB sensation

42
Q

what are concretions not related to

A

contact lenses

43
Q

what 2 palpebral changes are not related to contact lenses

A
  • follicles

- concretions

44
Q

what type of questions do you want to ask your patient to see if they have papillae

A

when the patient takes the lenses out, do they notice any roughness when blinking? do they have these same symptoms when they have their lenses in?

when the lenses are in, the patient will not feel the roughness from the papillae because the CL acts as a barrier over the cornea

45
Q

which regions of the palpebra are considered most relevant in CL wear

A

1, 2 and 3

46
Q

what should you use when recording changes to the palpebra

A

a grading scale e.g. CCLRU

47
Q

list the 5 signs of papillary conjunctivitis

A
  • Papillae
  • Redness – Hyperaemia
  • Mucus discharge
  • Lens deposition
  • Excessive lens movement
48
Q

list the 3 symptoms of papillary conjunctivitis

A
  • Px may have blurred vision due to lens deposits, mucus
  • May have itching
  • May have FB sensation
49
Q

which grade of papillary conjunctivitis is considered to be giant papillary conjunctivitis

A

grade 4 - severe

when the papillae are larger than 1mm

50
Q

as papillary conjunctivitis starts to get worse, where do the papillae tend to build up

A

along the bottom of the inverted eyelid

51
Q

list 6 possible causes of papillary conjunctivitis

A
  • Allergic (e.g. protein deposits on lens) or
  • Mechanical (lens design, modulus of lens material)
  • Hypersensitivity reaction mediated by Immunoglobulin E (IgE)
  • Associated with soft CL wear and stiffer materials e.g. SiHy
  • Associated with sensitivity to solutions or preservatives
  • Associated with MGD
    and atopy
52
Q

what is atopy

A

a hypersensitive type of patient with allergies

53
Q

list the 5 management options for papillary conjunctivitis and what must a patient have on them incase they can’t wear their lenses

A
  • Improve lens care regime
  • Daily disposables (if can’t clean lenses properly)
  • Alter lens design or material (not SiHy)
  • If required- mast cell stabilisers
  • Manage any lid margin disease

pc must have a spare pair of glasses on them

54
Q

what are the 3 types of conjunctival redness/hyperaemia

A
  • sectoral
  • interpalpebral
  • bulbar
55
Q

what is the likely cause of a sectoral conjunctival hyperaemia

A

a specific cause such as an infiltrate or eyelash rubbing against the eye

56
Q

what is interpalpebral hyperaemia associated with

A
  • chronic dryness and RGP wear

- it can be a allergic and/or mechanical cause

57
Q

what is bulbar hyperaemia most common with and also associated with

A
  • common with soft CL wear

- also a sign associated with many other serious conditions e.g. scleritis, uveitis

58
Q

if a bulbar hyperaemia is due to other more serious conditions, how may you rule this out

A

to do tests such as IOPs, van herrick, visions, staining, anterior chamber

59
Q

what are the 8 management options for conjunctival redness

A
  • Record-use grading scales (so somebody else can monitor)
  • Identify and address cause (do a ddx)
  • Refit- change lens design (e.g. looser)
  • Refit-change lens material e.g. different modulus or Dk
  • Refit- more frequent replacement (if protein deposits)
  • Review care regime
  • Ocular lubricants
  • Consider environmental factors
60
Q

name 2 main causes of conjunctival staining

A
  • Usually related to lens edge
    (tight fit or excessively loose lens
    moving too much) and/or dryness
  • Could be caused by solution
    toxicity
61
Q

what is the staining type of conjunctival staining and what can be used to enhance its appearance

A
  • may be punctate or confluent staining
  • could use written filter to enhance fluorescein visibility
  • lissamine green is also useful
62
Q

when can conjunctival staining start to get dangerous

A

when it encroaches onto the cornea

63
Q

what causes a furrow/arcuate conjunctival staining and which lenses is it associated with

A
  • when the superior lid comes down and presses on the CLs

- associated with tight fitting, high modulus or overnight wear/EW lenses

64
Q

what does the management go conjunctival staining spend on

65
Q

what is the management of conjunctival staining if it is due to dryness

A

treat with lubricants or take other appropriate action e.g. if down to MGD

66
Q

what is the management of conjunctival staining if it is due to the lens fit

A

refit the lens e.g. to a lower modulus lens e.g. if it was originally SiHy lens

67
Q

what is a conjunctival epithelial flap

A

Areas of loose conjunctival tissue

in area of lens indentation

68
Q

where is conjunctival epithelial flaps usually located

A

superiorly or inferiorly

69
Q

what is conjunctival epithelial flaps associated with and what does this cause

A

Silicone Hydrogel CL wear - which causes superficial layers of conjunctival cells to delaminate

70
Q

what is delimitation of conjunctival cells (found in a conjunctival epithelial flap)

A

the layers split into individual sheets and is lose

71
Q

which type of contact lens wearers is conjunctival epithelial cells found in as well as SiHy

A

RGP wearers

72
Q

what are the 3 management options of conjunctival epithelial flaps

A
  • Usually resolves upon ceasing CL wear
  • Use lower modulus lens
  • Reduce overnight wear

Contact lenses year 3 (15 decks)

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