Week 9 - Therapeutic Uses Of Contact Lenses Flashcards
Definition of medical contact lens:
• Definition: “any type of contact lens that is worn for the primary purpose of treating an underlying disease state or complicated refractive status. Medical contact lenses may or may not correct refractive error. Medical contact lenses are prescribed for reasons other than the cosmetic purpose of eliminating the need for spectacles”
Bandage contact lenses used when:
• Post refractive surgery
• Post corneal cross-linking
• Anterior segment wound leaks
• Entropion/trichiasis
• Recurrent corneal erosions
• Pain relief e.g. bullous keratopathy
Why bandage contact lenses used?
• Comfort (pain relief)
• Mechanical protection
• Promotion of healing
• Sealing of corneal perforations
• Delivery of medications
Considerations with bandage contact lenses:
• Wearing schedule
• Dexterity
• Age of patient
• Help available
• General health, medical history
• Can continue to use most other eye drops (just remember preservatives)
Risks with bandage contact lenses:
• Infections (often the cornea is already compromised)
• Lens intolerance
• Reduced oxygen to the cornea
Use of CL post refractive surgery:
• To protect the cornea
• Relieve pain
• Encourage corneal flap healing
• Used to be done for weeks but improvement in laser eye surgery only 1 day is needed
Post corneal cross-linking
• Bandage contact lens applied post cross-linking due to removed epithelium
• Removed a week later at the follow up check
• Worn extended wear
• Information from Optom at Gartnavel. May differ depending on the type of cross-linking carried out.
Anterior segment wound leaks;
• Can be used post cataract surgery, glaucoma filtering surgery or PK
• E.g. Large diameter soft lenses for leaking bleb, 2-4 weeks alongside topical antibiotics
• Post cataract instead of a eye patch, small scale studies show improvement in tear film stability and comfort without inhibiting the healing.
Over glue for perforations/lacerations
• Glue combined with a BCL to try and avoid surgery
• The surface of the adhesive is uneven and can be dislodged so the lens is essential
• Research so far is mostly case reports/series
Trichiasis:
• Aim is to protect a healthy cornea from damage
• Lashes can lead to corneal abrasions and increase risk of infection
• Bandage lens can be used DE or EW - SiHy or scleral
• Can be used while waiting longer term solution e.g. surgery
• Lunricating drops can continue to be used with lenses
Describe recurrent corneal erosion:
• Often post trauma e.g. abrasion
• Can also be due to corneal dystrophy
• Or idiopathic
• Usually report recurrent sharp pain, photophobia, blurred vision and lacrimation often during the night or on waking
Management for recurrent corneal erosions
• Initial management is with intensive lubrication including ointment overnight
• This can often be enough
• However if erosions occur weekly then consider bandage lens
- should be an EW licensed lens with high dK/t
- Need to wear lens for 3-4months to allow epithelium to fully attach to basement membrane
- Px often attends for lens to be changed monthly if struggle with I&R
• If cls dont work may refer for debridement
Pain relief/healing Contact lenses:
• Usually SiHy soft lenses or scleral lenses
• Chemical (alkali) injury (associated with persistent epithelial cell loss), can be just for comfort or also to hold tissue glue in place
• Bullous/exposure/neurotrophic keratopathy
• Filamentary keratitis/superior limbic keratoconjunctivitis
• Post phacoemulsification/ptosis repair/pterygium (debate in the literature)
• Severe dry eye disease (CLs are not a common management option) e.g. Sjogren’s syndrome
- May be secondary to other pathologies such as graft vs host disease or Steven
Johnson syndrome
- Often part of a multimodal treatment approach
Scleral lenses for ocular surface disease
• Chronic injury to the cornea
• E.g. Stevens Johnson and graft vs host disease
• Can be significant fibrosis on the palpebral conjunctiva
Keratoconus
• Does fit into this category as it can reach a point when glasses no longer correct the vision to a satisfactory level
