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Contact Lenses > Conjunctiva and Limbus in CL wear > Flashcards

Conjunctiva and Limbus in CL wear Flashcards

1
Q

What can cause bulbar conjunctiva and limbal hyperaemia?

A

Hypoxia
Hypercapnia
Acidic shift
Toxicity from drops or sols
Allergy
Inflammation
Infection
Mechanical aggravation/damage
Exposure (e.g. to AC)

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2
Q

What is hypercapnia?

A

Too much carbon dioxide

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3
Q

Why do soft lenses tend to lead to more redness than RGPs?

A

Soft lenses cross over the limbus and conjunctiva, so can cause more mechanical aggravation. RGPs don’t cross over the limbus.

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4
Q

At what stage does bulbar conjunctival hyperaemia need management?

A

If grade 2 or above

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5
Q

How do you manage bulbar conjunctival hyperaemia?

A

Find out if acute or chronic and work out cause
Stop CL wear if necessary
Change solutions
Bleph/MGD management
Check routine - remind of rub and rinse
Comfort drops
Find out about meds
Review and refer if necessary

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6
Q

What are some possible differential diagnoses of bulbar conjunctival hyperaemia?

A

Subconjunctival Haemorrhage
CLARE

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7
Q

What is CLARE?

What does it stand for?

A

Contact Lens Acute Red Eye

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8
Q

What are the features/causes of CLARE?

A

Features: Unilateral
Red, swollen eye from inflammatory response
Causes: Overwear/poor hygiene/sleeping/EW in CLs

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9
Q

What are the signs of CLARE?

A

Corneal infiltrates near limbus
AC flare
Endothelial bedewing
Conjunctival and limbal hyperaemia

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10
Q

What are the symptoms of CLARE?

A

AM onset
Pain
Tearing
Photophobia

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11
Q

How should CLARE be managed?

A

Stop CL wear until no infiltrates
No EW, change to DDs
Review same day to check sxs reducing
Improve lens hygiene/routine
Refit with looser lens
Therapeutic treatment if infiltrate >0.5mm

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12
Q

What is pinguecula and what is it’s management?

A

Chronic UV exposure has caused a degeneration of collagen fibres resulting in a yellow bump on sclera.
Asymptomatic
Surgical removal (rare)
Make sure lens doesn’t aggravate bump/s

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13
Q

What is pterygium and what is it’s management?

A

Chronic UV exposure has caused fibrovascular tissue to grow, invading cornea
Asymptomatic until grows over pupil
Surgical removal (if over pupil)
Fit with soft CL or small RGP if flat

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14
Q

When should limbal hyperaemia be managed?

A

> grade 1.5-2
OR > 1 grade change
OR if symptomatic

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15
Q

How should limbal hyperaemia be managed?

A

Change lens type to better Dk
SAME AS CONJ. REDNESS:
Find out if acute or chronic and work out cause
Stop CL wear if necessary
Change solutions
Bleph/MGD management
Check routine - remind of rub and rinse
Comfort drops
Find out about meds
Review and refer if necessary

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16
Q

What are possible differential diagnoses of limbal hyperaemia?

A

Limbal neovascularisation
Superior limbic keratoconjunctivitis

17
Q

What is superior limbic keratoconjunctivitis?

A

Delayed allergic reaction to sols or deposits and mechanical damage/hypoxia under upper lid

18
Q

What are dellen?

A

Dry spots from separation of lid from ocular surface (often caused by elevated structures like pterygium)

19
Q

What are the symptoms of dellen?

A

FB sensation
Mild photophobia

20
Q

How do you manage dellen?

A

Remove cause
Lubricants

21
Q

What is vascularised limbal keratitis? What causes it?

A

Localised desiccation at 3 and 9 o’clock on the limbus.
Caused by EW or RGPs

22
Q

What type of staining can occur in vascularised limbal keratitis?

A

3 and 9 o’clock staining

23
Q

What are the symptoms of vascularised limbal keratitis?

A

Mild dryness
Mild lens awareness
Discomfort (if severe)

24
Q

What are the signs of vascularised limbal keratitis?

A

Increased tissue and inflammation on limbus at 3 and 9 o’clock
Limbal vessel encroachment
Superficial punctate staining
Mild corneal infiltrates near limbus

25
Q

How should vascularised limbal keratitis be managed?

A

No CLs for 1-3 days
Refit to DDs if EW
Refit RGP with flatter peripheral curves/smaller diameter or to soft lens

26
Q

What factors increase limbal redness?

A

Hypoxia
Hypercapnia
Infection
Inflammation
Trauma from damaged lens
Solution toxicity or hypersensitivity
Lens deposits

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