Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Contact Lenses - Year 2 > Staining and Ocular Response to CL > Flashcards

Staining and Ocular Response to CL Flashcards

1
Q

Why do you want to conduct an after care appt?

A

Ensure optimum comfort and optical performance

  • Minimise drop-outs
  • Answer patient queries/questions
  • Address any compliance issues – Safety: reduce risk of infection
  • Assess the ocular reaction to a lens
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you conduct an appt for a new fit of contact lenses?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How do you conduct an aftercare appt?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does a history and symptoms check for contact lenses differ to that of a routine check up?

A

CL history and syptoms focuses on the motivation for contact lenses and whether CL are appropriate for how the px wants to wear them

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some common reasons for why patients chose to wear CLs?

A

For Cosmetic purposes i.e. they have a high Rx or anisometropia.

Sports where glasses are impractical

Special Occasions

Therapeutic Reasons i.e. for some ocular conditions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What should be recorded in a history and symptoms of a CL aftercare appt?

A

What type of visit is it? • Routine? • Unscheduled visit?

A Determination of whether there are any problems

A Follow up of advice that was given at the previous visit

e.g. • Use of eye drops • Advice regarding wear time

How the px feels about vision in their contact lenses.

Ocular Health

Medications

Lifestyle/Hobbies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What vision related questions are we asking our px in history and symptoms for a CL aftercare appt?

A

We are asking how their vision is in the CLs and how that compares to their glasses.

We ask whether the patient is experiencing any fluctuations in vision - if so when?

Whether blinking has any effect on their vision.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What vision related questions are we asking our patient in history and symptoms for a new fit CL appt (and why)?

A

What is the VA like compared to their glasses?

In order to determine the presence of any issues that may affect the VA through CLs e.g. amblyopia or presbyopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What questions do we ask in regards to ocular health in the history and symptoms portion of a CL aftercare appt?

A

Any new problems?

COMFORT:

• Issues when wearing CLs? e.g. about Lenses drying out, ocular discomfort, redness, pain?

QUS ABOUT LENSES:

• Age of lens/case? • Cleaning of lenses/case? • Solution?

WEAR TIMES:

Days (/7), hours (/24), max, average, and today, as well as comfortability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What do we check in regards to ocular health in the history and symptoms portion of a CL new fit appt?

A

Check for symptoms

  • Are there any contraindications to lens wear? (such as a red or pink eye, or discharge etc)
  • Does patient require treatment prior to fitting?
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are very important symptoms to look out for?

A

Light sensitvity (photophobia)

Discharge

Pain

Sudden blurry Vision/Vision loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If a patient complains of any symptom how do we investigate this further- i.e. what questions to we ask?

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does CLPC stand for?

A

Contact Lens Pupillary Conjunctivitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If a patient experiences a sudden onset of discomfort or discomfort upon insertion of the contact lens what are some possible causes for this?

A

A foreign body

A damaged lens

Conjunctival irritation

Corneal Abbrasion

Excessive movement of the lens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

If a patient experiences discomfort after during a period of wearing CLs what could be the cause of this?

A

Lens Deposits

Ocular surface Dehydration as a result of wetting properties of the lens

Issues with the environment in which the lens is worn i.e. dry environment - lots of air conditioning

Trapped Debris

CLPC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

If a patient experiences discomfort after a period of wearing contact lenses - what are possible causes of this?

A

Corneal Abraison

SEAL - Superior Epithelial Arcuate lesion

Inflammation/Infectin

[Here the CL acts as a bandaid and whenremoved the px experiences symptoms]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

If a patient is experiencing constant blurred vision with their CLs on, what may be the possible cause of this?

A

They’ve accidentally switched their lenses i.e. Left CL in right eye and Right CL in the Left eye.

The Rx is incorrect

They are experiencing residual astigmatism

The lens is distorted

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

If a patient is experiencing blurred vision that fluctuates with blinking whilst wearing their CLs , what may be the cause of this?

A

Any one of the following could be a possible cause:

  • Lens deposits (if vision is better post blinking)
  • Excessive lens movement (if vision is worse post blinking)
  • The lens has been inserted inside out (i.e. not the boat shape)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

If a patient experiences blurred vision with their CLs throughout the course of the day whilst wearing them, what may be a possible cause of this?

A

Lens Deposits

The lens surface drying out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are a list of possible triggers for any symptom a px experiences with CLs?

A

The lenses themselves

The lens case

The lens solution

The environment in which they are worn

The px themsleves by being irresponsible i.e. showering or swimming in lenses, creams , makeup etc.

(A combination of all these factors)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Why is it helpful to ask a patient about the severity of a symptom?

A

Despite it being subjective it can be a good way of monitoring progression/ changes to symptoms.

Also allows us to record if any treatments were particularly effective at removing symptoms such as discomfort.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

When recording previous Ocular history as part of history and symptoms, for a new fit CL appt what types of questions do we want to be asking and why?

A

We want to be asking whether they have suffered from any eye conditions as that may affect the type of lens we prescribe.

If they have worn contacts before we want to ask why they stopped wearing contacts so that we can resolve any previously experienced problems - in this case, we also want to be recording which lenses those were.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What questions are we asking and focusing on when recording ocular history in a CL aftercare appt?

A

Checking previous records and confirming them

Asking about whether the px is experiencing any new symptoms or any conditions which may affect the eyes and subsequently lens wear.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What allergies/conditions should we be asking our patient about, due to their systemic association with the eyes and as a result CL wear?

A

General Allergies

Presence of Ezcema

Diabetes

Rheumatoid Arthritis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are lifestyle questions that we may ask our px in regards to contact lenses?

A

Whether the patient smokes, drives, uses VDTs etc,

and whether they do these with their lenses in

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Records of which medication are particularly important to note when fitting contact lenses?

A

Medication that affects the anterior eye e.g. the cornea , tears, wetting properties etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Why is it important to ask about family ocular history/General Health?

A

To establish whether the pateint is susceptible to any hereditary anterior eye conditions that may affect lens wear.

(Such as keratoconus).

28
Q

What are the two most common grading scales for the fit of CLs?

A

The CCLRU grading scale and the EFRON grading scale.

29
Q

What are the advantages and disadvantages of the CCLRU grading scale?

A

Advantages - it uses real eyes

Disadvantages- They are not all the same eye and pictures are at different illuminations

30
Q

What are the advantages and disadvantages of the EFRON grading scale?

A

Advantage- Precise Severity is shown . There is also image consistency

Disadvantage- Not ‘real’ eyes

31
Q

Why is it legally important to always use a scale and record symptoms in a CL appt?

A

It is proof that a standard of care was met

32
Q

Describe the similarities and differences between a CCLRU scale and an EFRON scale.

A
33
Q

In regards to record keeping of symptoms what must we always make sure we are doing?

A

Choosing a scale and sticking with it (so we can monitor symptoms)

  • Always writing which scale we used
  • Making sure we Grade to the nearest 0.1

[• Don’t guess the scale, look it up – Grade ≥ 1.0 is clinically significant – Grade ≥ 3.0 requires management plan]

34
Q

How can we determine the depth of corneal staining?

A

When you observe staining you go to a corneal optic section.

35
Q

What are the different types of corneal staining patterns?

A
36
Q

What is the typical cause of smile staining?

A

Incomplete blinking leading to dry eye

37
Q

Why may foreign body staining be found in contact lens wearers?

A

Because something is trapped behind the contact lens.

38
Q

Why may a SEAL (superior-epithelial arcuate lesion) occur with contact lens wear?

A

It is a result of mechanical pressure due to the design of the lens or lens material.

39
Q

How is dessication staining in RGP wearers viewed?

A

As 3 and 9 o clock staining that tends to cross the limbus

40
Q

What kind of staining is a toxicity staining and why would it occur in a contact lens wearer?

A

A diffuse stain.

It may occur as a pateint has a reaction to the solution in the blister pack

41
Q

What are asymptomatic Infiltrative keratitis?

What are they a response to?

A

They are Sterile corneal infiltrates — they are formed as Inflammatory cells from limbal blood vessels form white spots in cornea (arrow in the picture points them out)

• In response to hypoxia, bacteria, lens deposits, allergic reaction, poor hygiene etc

42
Q

What is the management for Asymptomatic infiltrative keratitis (AIK)?

A

Temporary discontinuation of lens

– Careful monitoring

– Ocular lubricants and cold compresses

43
Q

What are asymptomatic inflitrates?

and how do they differ from Asymptomatic Infiltrative keratitis?

A

Inflammatory cells from limbal blood vessels form white spots in cornea (Same as AIK)

They are smaller and milder and no redness is experienced with them.

44
Q

What is the treatment for asymptomatic infiltrates (AI)?

A

– Temporary discontinuation of lenses

– Careful monitoring

– Ocular lubricants and cold compresses

45
Q

What is SEAL staining?

How may it present?

A

Staining due to Mechanical pressure as a result of lens design or material • Arcuate staining parallel to superior limbus (see picture)

• Usually unilateral, asymmetric, mildly symptomatic

46
Q

What is the management of SEAL staining (Superior Epithelial Arcuate Lesion)?

A

Remove lens, cease CL wear for x days (depends on severity), issue lubricants, review lens fit:

– Use thinner, more flexible lens material

– Change back surface geometry of the CL

47
Q

Why may contact lens associated papillary conjunctivitis occur?

A

Due to an Immunological response due to hypersensitivity to lens deposits or solution – Or mechanical response due to lens design or modulus

48
Q

What is the management for Contact lens associated papillary conjunctivitis?

A

Manage if grade >2

– Lens wear can continue if symptoms permit

– Improve lens hygiene (cleaning and wearing time modality) - instruct your px on this!

49
Q

What is CLARE?

A

Contact lens Acute Red Eye.

Inflammatory response of cornea and conjunctiva subsequent to period of eye closure with CL wear – due to endotoxins from gram negative bacteria (especially Pseudomonas spp)

50
Q

How does CLARE present?

A

Unilateral, acute hyperaemia, diffuse infiltrate keratitis, possibly anterior chamber reaction.

With patients most complaining complaining that they woke at night with a painful red eye.

51
Q

What is the managment for Contact Lens Acute Red Eye (CLARE)?

A

– Condtion is Self limiting so conservative management

– Temporary discontinuation CL wear

– Careful monitoring

52
Q

Why does a contact lens peripheral ulcer occur?

A

It is an inflammatory response to gram positive bacteria (esp staphylococcus spp) – due to e.g. bacterial contamination, poor hygiene, hypoxia, solution toxicity

53
Q

What symptoms are experienced with a contact lens peripheral ulcer?

A

50% of cases are asymptomatic

Those that are not experience:

  • Lens intolerance
  • foreign body sensation
  • lacrimation
  • photophobia

[Lens removal reduces symptoms]

54
Q

What are the signs of a contact lens peripheral ulcer?

A

Localised hyperaemia (around the ulcer) and a sterile circular infiltrate (which is the ulcer itself).

55
Q

What is the management for a contact lens peripheral ulcer?

A

It is self-limiting on removal of the lens but close monitoring for 24hrs is required to ensure differential diagnosis from MK (microbial keratitis)

– Can prescribe Ocular lubricants, inform the px about lid hygiene,

and referral only in severe cases (i.e acute red eye or no improvement after lens removal)

56
Q

What are the symptoms of microbial keratitis (MK)?

A

– Pain, moderate to severe (acute onset, rapid progression)

– Redness,

  • photophobia (may be severe),
  • discharge,
  • blurred vision (especially if lesion on visual axis)

– Px Awareness of white or yellow spot on cornea

– Usually unilateral

57
Q

What are signs of microbial keratitis?

A

– Lid oedema

– Epiphora

– Discharge (muco)purulent

– Conjunctival hyperaemia and infiltration

– Corneal lesion usually single (central or mid-peripheral)

– Anterior chamber activity (flare, cells, hypopyon or coagulum if severe)

58
Q

How many times more likely is Microbial Keratitis as a result of Extended wear as a pose to daily wear?

A

5x more common with EW vs DW

59
Q

How does the risk of Microbial Keratitis vary with RGPs as a pose to SCL?

A

Risk of infection with RGP is approx 1/3 compared to daily SCLs

60
Q

True or False- MK is rare and is the only serious adverse event to occur in contact lens wear

A

True - All adverse reactions and their seriousness can be seen in the traffic light table below.

61
Q

Which pathogens can cause microbial keratitis?

A

– Bacteria (especially Pseudomonas spp)

– Virus

– Fungus

– Amoebae

62
Q

True or False- MK can cause sight loss

A

True - can cause Vision loss in 2 per 10,000

63
Q

What is the managment for Microbial Keratitis?

A

Discontinue CL wear and urgent referral to HES

64
Q

What are the differences between a contact lens peripheral ulcer and microbial Keratitis?

A
65
Q

How often should an aftercare appt be done?

A

Once a year due to its invasive nature but you can see them sooner if you feel it is appropriate

66
Q

What advice and recommendations do we give following a new fit appt?

A

Explain whether eyes are suitable for lenses or not and why.

Adress any concerns with ocular health and book an appt.

Book a follow up appt.

67
Q

What advice and recommendations do we give following an aftercare appt?

A

Contact Lenses - Year 2 (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions