Week 1.09 Contact Lens Complications Flashcards
Meibomian gland dysfunction
Chronic
Duct obstruction
Cl wear possibly causal
MGD can be associated with problems with cl wear due to poor tear film
What are some symptoms of CLIPC
Discomfort
Blurred vision
Increased mucus on waking
Excessive lens movement
Reduced lens wear
Signs:
Papillae on tarsal conjunctiva
Stringy mucous deposits
Conjunctival hyperaemia and oedema
What are the symptoms of superior limbic keratoconjunctivits
Lens awareness
Foreign body sensation
Burning
Itching
Photophobia
Redness
What can be the cause of superior limbic keratoconjunctivitis
Thimerosal(preservative) hypersensitivity
Top of cornea gets most pressure due to relationship of lens with lid
Lens deposits
Hypoxia
What’s the treatment for superior limbic keratoconjunctivits
Cease lens wear
Change lens
Eliminate thimerosal
What are the causes of limbal hyperaemia
Short term sign of clinical hypoxia
Can be tight lens or irritation due to poor lens fit
Management of limbal hyperaemia
Cease lens wear
Refit with higher Dk/t lens
Reduce wt
SEAL
Superior epithelial arcuate lesion
Asymptomatic
Mechanical cause - chafing
Often SiH
Refit with material of lower modulus or better wettability
Epithelium microcysts
Small scattered dits
Seen in low Dk/t lens not SiH
Corneal neovascularisation
Associated with chronic hypoxia
Ghost vessels
Superficial - vessels continue from conjunctiva
Deep - stromal vessels emerge from sclera
Treatment for corneal neovascularisation
Cease lens wear
Increase Dk/t reduce WT refit with RGP
What is CLARE
Contact lens acute red eye
Inflammatory response in EW
Pain wakes px
Infiltrates
Photophobia
Treatment of CLARE
Remove lens
Cease lens wear till resolved
May take weeks
What is CLPU
Contact lens induced peripheral ulcer
Inflammatory response
Corneal infiltrate
Self limiting - resolves to bulls eye scar
Most px are asymptomatic
How do we differentiate between CLPU and ML using PEDAL
Pain - in MK severe, in CLPU asymptomatic
Epithelial defect - if no defect or mild defect then CLPU monitor carefully to check if worsens or reduce
Discharge - CLPU is inflammatory but no discharge likely MK
Anterior chamber response - assume infection and refer
Location - MK tend to have central or mid peripheral ulcer Inflammatory response
What’s the difference between sterile and infectious infiltrates
Sterile smaller and peripheral - infection larger and central
No mucous discharge - discharge
Less pain and photophobia - pain and photophobia
No lid involvement - lid oedema
Little/no anterier chamber reaction - anterior chamber reaction
Viral keratoconjunctivits
Not CL complication
Looks like infiltrative keratitis
- Epithelial lesions gradually coalesce and form coarse spots of sub epithelial infiltrates, may persist for weeks, months or even years
Endothelial blobs
Absence of cells
No sxs
Cause - oedema, vacuoles, bulging of posterior surface of cell
No tx needed
Disappear 10 mins post removal
Endothelial polymegathism
Increased variation of cell size
No sxs
Due to hypoxia
Tx - increase Dk/t
