5.2.1 Manages aftercare of SCL's 2 X APR

Question 1

What are the 2 types of blepharitis?

Answer 1

 Anterior Blepharitis
 Meibomian Gland Dysfunction (MGD)/ Posterior Blepharitis
*Can get mixture of 2 conditions

Question 2

What is anterior blepharitis caused by ?

Answer 2

 Not CL related, bacterial (usually staphylococcal) or seborrheic cause

Question 3

What are the signs & symptoms of Anterior Blepharitis?

Answer 3

> Symptoms: discomfort, FB sensation, itching, burning, lids

> Signs: Red/swollen lid margins, crusting at lash base

Question 4

What is (MGD)/ Posterior Blepharitis caused by?

Answer 4

Not CL related , caused by: >mechanical trauma
>lowering of eyelid temp
>microbial contamination
>eye make up

Question 5

What are the signs and symptoms of MGD?

Answer 5

> Signs: Blocked glands , Frothy tears , dry eyes , lipid deposits/ greasy lipid layer on lens surface etc
Symptoms: dry - itchy eyes and CL intolerance

Question 6

What is the management for ANT + POST bleph?

Answer 6

> BOTH: Manage grade 2 + or symptoms. (continue wear if tolerated). Explain chronic nature

Anterior Blepharitis:
-Cease CL wear until resolution -increase hygiene with hot
compresses and lid scrubs 2* day
MGD:
- Hot compresses, lid massage and lid scrubs
- adv diet e.g omega-3/ environment

Question 7

What complications are still common/ not common with SiHy?

Answer 7

Shouldn’t see:
- hypoxic complications e.g corneal oedema / vascular
changes.

• Only in High modulus 1st gen SiH may cause mechanical complications e.g: mucin balls, SEALs and CLIPC
• Infiltrative Keratitis (IK): still see as you would in hydrogels

Question 8

What are the signs & symptoms of Mucin balls?

Answer 8

Symptoms: none, vision can be affected in extreme cases

Signs:
Lens in place:
-small , white round bodies between lens + cornea + stain with NAFL
-location: pre-epithelium (don’t breach epithelial integrity)
-Contain - mucin ,tear proteins and lipid
Lens removed:
-disappear with few blinks or become embedded in cornea leaving corneal epithelial depression.

Question 9

What are the signs & symptoms of SEALs?

Answer 9

*Superior Epithelial Arcuate Lesions

Symptoms: asymptomatic - may get burning or itching feel.

Signs: Arcuate staining in superior cornea , raised excavation (digging).
Full thickness epithelial defect in part covered by upper eyelid

Question 10

What is the main cause for Mucin balls or SEALs?

Answer 10

Mechanical interaction / complication
(was more common previously with high modulus 1st gen lens)

Question 11

What is the management for mucin balls and SEALs?

Answer 11

Mucin balls:
Refit with different material or lower modulus
(can do nothing- as vision/comfort unaffected)

SEALs:
Cease wear until resolves then refit with different material or design.

(softer with lower modulus - more flexible.
thinner periphery , maybe flatter BOZR)

Question 12

What are the signs & symptoms of CLIPC?

Answer 12

Signs:
Upper tarsal Papillae (0.3-1mm) or giant papillae (> 1 mm) - who’s apices stain with Fl &apices appear whitish in chronic cases,
-Upper tarsal hyperaemia, and conjunctival
oedema
-stringy mucus discharge

Symptoms:
-Itching and irritation, mucus discharge
-increased lens movement -lens intolerance & and blurred vision

Question 13

What are the signs and symptoms of solution toxicity?

Answer 13

Signs: Diffuse generalised, punctate corneal staining (all over cornea)

Symptoms: red eye, itching,
tearing, CL intolerance

Question 14

What causes solution toxicity and what is the management?

Answer 14

-Allergic reaction to preservatives in solution

Management: Let eye heal then try different lens solution brands/formulations or non
preserved solution

Question 15

What is the management of CLIPC?

Answer 15

Management:
-Improve lens hygiene (daily surfactant cleaning or change to preservative free)
-cease lens wear until resolves then reduce WT or change to dailies SCL.
- to material with improved deposit resistance or
- lower modulus, and/or change edge profile

Question 16

Name 3 chronic CORNEAL hypoxic complication + location?

Answer 16

-Microcysts: long-term hypoxia on corneal epithelium
-Striae/folds/haze
(oedema), thinning,
vascularisation: hypoxia on corneal stroma
-Blebs,
polymegathism: hypoxia on corneal endothelium

Question 17

Name 2 vascular hypoxic complications?

Answer 17

Neovascularisation:
- hypoxia
or mechanical
aetiology
Limbal hyperaemia:
-depends on peripheral Dk/t
values, seen less in
high Dk/t lenses

Question 18

What % oxygen
deprivation causes
striae, folds and
haze?

Answer 18

haze: caused by 20% loss of 02
to cornea
folds : caused by 10% hypoxia
striae: about 5% o2 deprivation

Question 19

What is a microcyst , symptoms and management?

Answer 19

not common

Microcysts:
- found in corneal epithelium due to oedema caused by chronic hypoxia
-Tiny round vesicles- dots on cornea

Symptoms: none /mild hazing of vision

Management: Cease lens wear until resolves , then Increase Dk/t and reduce WT

Question 20

What are striae , folds & haze. symptoms and management?

Answer 20

like microcysts - are due to chronic hypoxia - cause corneal oedema but in the STROMA.

-Striae: fine vertical lines (asymptomatic)
-Folds: depressed groove or raised edges
(hazy vision/discomfort)
-Haze: loss of corneal transparency

folds + haze can take up to months to heal- unlikely to see - more likely after cataract op.

Management:
-Striae- increase Dk/t and reduce WT
-Folds/haze- Cease lens wear until resolves then
increase Dk/t and reduce WT

Question 21

What are the 3 examples of endothelial complications of hypoxia?

Answer 21

• Bedewing
  -Blebs
  -Polymegathism

Question 22

What is Bedewing? (include all info)

Answer 22

-swollen (oedematus) particles on endothelium
- Existing CL wearers develop gradual CL intolerance

Management: Reduce or cease lens wear

Question 23

What is a bleb (all info )?

Answer 23

-endothelial cell oedema- due to hypoxia.
-leads to black non-reflecting areas in endothelium (specular)
symptoms: none
Manage: by increasing DK/t

Question 24

What is polymegathism? (all info)

Answer 24

-Permanent change in endothelial cells (specular refl- never really goes back to endo mosaic)
-Variation in cell size
Symptoms: none
-Management: Reduce WT and increase Dk/t