5.2.1. Manages the aftercare of patients wearing soft lenses.

Question 1

How to prevent Dryness caused by cls…

Answer 1

Low Water Content (WC) Lenses:

Prevent lens dehydration and maintain comfort.
Avoid further dehydration caused by high WC lenses.
Silicone hydrogel (SiH) lenses combine low WC with improved oxygen transmissibility, nourishing the eyes and preventing oxygen deprivation-related complications.
Contact Lens-Induced Dry Eye (CLIDE):

Tear film is divided into pre- and post-lens layers after contact lens application, causing tear thinning, reduced lubrication, and increased friction.
Results in dryness and discomfort.
Management options:
Use rewetting drops and/or blinking exercises.
Refit with daily disposable or gas-permeable (GP) lenses.
Switch to preservative-free solutions.
Punctal Occlusion:

The puncta are small openings near the edges of the eyelids that drain tears.
The painless procedure involves blocking these openings to retain more tears on the eye’s surface.
Enhances tear retention, increasing lubrication and reducing dryness.

Question 2

MGD

Answer 2

• Meibomian Gland Dysfunction (MGD):
  
  • Meibomian glands along the eyelid margin produce meibum, an oil that prevents tears from evaporating too quickly.
  • MGD occurs when glands become inflamed, clogged, or produce insufficient/poor-quality oil, leading to rapid tear evaporation.
  • Obstructive MGD is the most common form, caused by clogged glands reducing oil flow to the eye surface.
• Management:
  
  • Dry Warm Compresses:
    
    • Apply to eyelid skin twice daily for at least 5 minutes at ~40°C.
    • Use commercial products (e.g., EyeBag) or a hot flannel to maintain consistent heat.
  • Contact Lens Adjustments:
    
    • Increase lens replacement frequency.
    • Ensure careful lens cleaning with a surfactant.
    • Use silicone hydrogel (SiH) lenses for low water content.
  • Dietary Support:
    
    • Omega-3 supplements improve the quality of meibum produced by the glands.

Question 3

Anterior blepharitis

Answer 3

• Blepharitis:
  
  • Inflammation of eyelash roots caused by a reaction to bacterial toxins.
  • Excess bacteria at the lash base leads to crusting.
  • Seborrheic Blepharitis:
    
    • Caused by a gland disorder in the eyelashes.
    • Results in greasy, crusty lashes that stick together.
• Management:
  
  • Discontinue contact lens (CL) wear until blepharitis clears.
  • Increase lens replacement frequency.
  • Ensure careful lens cleaning.
  • Use silicone hydrogel (SiH) lenses for low water content if dryness is present.
  • Perform eyelid scrubs twice daily for at least a week:
    
    • Scrub each eyelid for 1 minute to remove crust, loosen lashes, and reduce bacteria.

Question 4

LWE

Answer 4

• Friction from Blinking:
  
  • A small part of the upper eyelid contacts the eye’s surface during a blink.
  • Lack of lubrication causes trauma and friction in this area.
  • Identified using lissamine green dye.
• Management:
  
  • If caused by dry eyes (aqueous deficiency), use rewetting drops.
  • Change to a lens design with reduced thickness.

Question 5

Keratoconus

Answer 5

• Keratoconus:
  
  • A non-inflammatory condition where the cornea thins and bulges into a cone shape.
  • Impairs focus and causes poor vision.
• Management:
  
  • RGP Lenses (Rose K2):
    
    • Create a regular refracting surface by adjusting front and back curves.
    • Optimizes the focal point and reduces ghosting images.
  • Collagen Cross-Linking:
    
    • Strengthens corneal collagen to prevent progression.
    • Procedure:
      
      • Numbing and riboflavin drops applied for 30 minutes to soak into the cornea.
      • UV light exposure for 60–90 minutes to tighten collagen fibers.

Question 6

Redness cause

Answer 6

• Mechanical - steep fit
• Metabolic - hypoxia or hypercapnia
• Infectious - keratitis
• Inflammatory - CLARE
• Toxic - solution
• Environment - dryness, dust/dirt/grit

Question 7

CLAPC

Answer 7

• Contact Lens-Induced Papillary Conjunctivitis (CLPC):
  
  • Inflammatory condition causing bumps on the underside of the upper eyelid.
  • Often caused by mechanical irritation from contact lenses or issues with cleaning/solutions.
• Management:
  
  • Non-Pharmacological:
    
    • Remove Lens Deposits:
      
      • Replace soft lenses more frequently.
      • Improve hygiene with rigorous surfactant cleaning and frequent enzyme use.
      • Polish or replace rigid lenses.
    • Reduce Exposure Time:
      
      • Avoid extended wear.
      • Minimize daily wearing time.
      • Temporarily cease lens wear if necessary.
    • Optimize Lens Fit, Material, and Regimen:
      
      • Rigid lenses: Adjust diameter, edge clearance, or thickness.
      • Soft lenses: Switch to deposit-resistant material or lower modulus lenses.
      • Consider daily disposable soft lenses.
    • Ocular Prostheses: Polish, adjust, or replace if relevant.
    • (GRADE: Low evidence; strong recommendation)
  • Pharmacological:
    
    • Use topical mast cell stabilizers (e.g., sodium cromoglicate 2% or lodoxamide 0.1%) 4x/day for 28 days.
    • Optrex Allergy 2% w/v Eye Drops available commercially.
      
      • Can be used with ongoing lens wear but avoid preserved drops with soft lenses in situ.

Question 8

CLARE

Answer 8

• Acute Unilateral Inflammatory Response:
  
  • Caused by bacterial toxins trapped under a contact lens due to poor hygiene and tight lens fit.
  • Results in corneal infiltrates (clusters of inflammatory cells), which must resolve before resuming lens wear.
  • Common in extended wear (EW) or over-wearing lenses.
• Symptoms:
  
  • Morning pain (due to increased edema and tighter fit).
  • Photophobia, redness, and watering.
• Signs:
  
  • Conjunctival and limbal hyperemia.
  • Infiltrates near the limbus.
  • Cells and flare in the anterior chamber.
  • Endothelial bedewing.
• Management:
  
  • Cease lens wear; review same day if possible.
  • Switch to daily wear (DW); resume wear only after infiltrates resolve (may take a few weeks).
  • Improve lid and lens hygiene, and consider flattening the lens fit.
  • For infiltrates >0.5 mm, initiate therapeutic treatment with chloramphenicol.

Question 9

Allergic Conjunctivitis

Answer 9

• Seasonal Allergic Conjunctivitis (SAC):
  
  • Eye component of hay fever, affecting ~20% of adults.
  • Triggered by airborne allergens (e.g., grass pollen, most common in June–July).
  • Allergic reaction releases histamine, causing conjunctival redness, swelling, watering, and itching.
  • Often associated with nasal, throat, sinus symptoms, and sometimes asthma, eczema, or food/drug allergies.
  • Does not harm vision but can disrupt daily life.
• Management:
  
  • Non-Pharmacological:
    
    • Identify and avoid allergens.
    • Use cool compresses for symptom relief.
    • Advise against eye rubbing to prevent mast cell degranulation.
    • (GRADE: Low evidence; strong recommendation)
  • Pharmacological:
    
    • Ocular Lubricants: Provide symptom relief.
      
      • (GRADE: Low evidence; strong recommendation)
    • Topical Treatments:
      
      • Mast cell stabilizers (e.g., sodium cromoglicate, lodoxamide).
      • Antihistamines (e.g., antazoline).
      • Combination antihistamine + mast cell stabilizers (e.g., olopatadine, ketotifen).
      • NSAIDs (e.g., diclofenac sodium).
    • Systemic Antihistamines:
      
      • Oral cetirizine or loratadine (once daily).
    • Consider compliance, cost, and preservative-free formulations when choosing medications.
    • Dual-action antihistamines (twice daily) may benefit contact lens wearers and school-age children.

Question 10

Pterygium

Answer 10

• Pterygium:
  
  • Triangular thickening of the conjunctiva extending onto the cornea, usually at the 3 o’clock or 9 o’clock positions (commonly nasal side).
  • Can cause astigmatism and reduce visual sharpness due to tension on the cornea.
  • Often causes irritation and cosmetic concerns.
  • Caused by long-term exposure to UV light, dust, and wind, more common near the equator.
• Management:
  
  • Non-Pharmacological:
    
    • UV Protection:
      
      • Advise wearing a brimmed hat, tinted lenses, and wrap-around sunglasses to reduce progression and irritation.
      • (GRADE: Low evidence; strong recommendation)
    • Measure and diagram the pterygium (photodocument if possible).
    • Use cold compresses when inflamed.
      
      • (GRADE: Low evidence; strong recommendation)
  • Pharmacological:
    
    • Ocular Lubricants:
      
      • Use lubricating drops during the day and unmedicated ointment at bedtime.
      • Switch to unpreserved preparations for patients with sensitivities.
      • (GRADE: Low evidence; strong recommendation)
    • Acute Inflammation:
      
      • Use a short course of non-penetrating topical steroids (e.g., fluorometholone, loteprednol) or topical NSAIDs (off-license use).
    • Monitoring:
      
      • Check intraocular pressure for patients on topical steroids.

Question 11

VLK (vascularised limbal keratitis)

Answer 11

• Symptoms:
  
  • Red area near limbus, stinging, foreign body (FB) sensation, inflammation.
  • Inadequate tear film and wetting causing epithelial keratopathy.
  • Potential association with extended wear (EW) RGP lenses.
• Differential Diagnosis (DD):
  
  • Pterygium: Redder on conjunctiva with symptoms present.
  • Corneal neovascularization: Unlikely with RGP wear, no symptoms or corneal opacities.
  • Dellen: No staining, has NaFl staining pool instead.
• Signs:
  
  • Vascularized area at 3 & 9 o’clock, extending from conjunctiva to cornea.
  • Staining in this region, occasional corneal infiltrates.
• Management:
  
  • Consider ceasing lens wear until resolved.
  • Improve RGP lens fit.
  • Switch to soft lenses, daily disposables (DD), or silicone hydrogel (SiHy).
  • Use lubricants for relief.

Question 12

Dellen

Answer 12

• Symptoms and Signs:
  
  • Area of dryness, thinning, and desiccation of the epithelium at 3 & 9 o’clock, near elevated structures (e.g., pterygium, tumor).
  • Redness, foreign body (FB) sensation.
  • Depressed region with defined margins (2-3mm).
  • Base of lesion appears hazy and dry, adjacent cornea normal.
  • Lesion will stain and pool slightly with NaFl.
• Causes:
  
  • Ocular trauma or surgery (e.g., cataract).
  • Contact lens (CL) wear.
  • Secondary to paralimbal elevation (e.g., limbal tumor, pterygium, pinguecula).
• Differential Diagnosis (DD):
  
  • Pterygium: More vascularized, limbal opacities, extends further.
  • Pinguecula: Yellowish, no corneal involvement.
• Management:
  
  • Untreated, may lead to corneal scarring, vascularization, and reduced vision.
  • Eliminate cause (e.g., pterygium, CL wear).
  • Use lubricants every 3 hours for one week.
  • Cease CL wear and review after one week.

Question 13

Limbal redness

Answer 13

Normally from overwearing lenses or not enough O2. Can also be inflammatory/toxic/mechanical etc

Management:

Treat cause e.g. reduce WT, more O2

Question 14

Neovascularisation

Answer 14

• Hypoxia and Neovascularization:
  
  • Lack of oxygen causes eye vessels to form new, weak vessels that may impair vision and are difficult to reverse.
  • Can lead to complications like infection.
• Types of Neovascularization:
  
  • Superficial Neovascularization: Minute branches form at right angles to the plexus, encroaching on the cornea.
  • Deep Stromal Neovascularization: Breakdown of normal stromal structure; large feeding vessel forms finer, tortuous branches.
  • Vascular Pannus: In-growth of limbal tissue onto the cornea.
  • Ghost Vessels: Larger feeding vessels regress after lens wear stops, leaving smaller vessels that fade. These “ghost” vessels can refill when lens wear resumes.
• Differential Diagnosis (DD):
  
  • Pterygium or VLK: Both have symptoms but are more localized, while neovascularization occurs around the cornea.
  • Pannus: Typically surrounds corneal lesions like marginal keratitis or trichiasis.
• Management:
  
  • Cease lens wear for 1 week if severe.
  • Consider daily wear lenses.
  • Use silicone hydrogel (SiH) lenses for more oxygen.
  • Weight down lens wear time.
  • Monitor carefully with a 6-month recall.

Question 15

Stroma straie?

Answer 15

Straie —> Folds —> Haze

Vogt’s striae have other signs of keratoconus & go with pressure to the globe

Question 16

CLPU

Answer 16

• Corneal Inflammation:
  
  • Inflammation caused by bacteria on the contact lens surface.
  • Peripheral corneal tissue erosion leading to opacity.
  • Gram-positive bacteria release toxins causing the inflammatory response.
• Differential Diagnosis (DD):
  
  • Scarring: Ask about a history of ulcers. If it doesn’t stain, it’s likely scarred.
  • Must differentiate from microbial keratitis (MK).
• Causes:
  
  • Poor hygiene and extended wear (EW) are typical causes.
• Symptoms:
  
  • Foreign body (FB) sensation, redness, mild photophobia.
  • Relief upon lens removal.
• Signs:
  
  • Circular infiltrate (0.2-1.0mm), overlying epithelial staining, scarring may remain.
• Management:
  
  • Should resolve after lens wear stops.
  • Prophylactic antibiotic: Chloramphenicol drops, every 2 hours for the first 2 days, then every 4 hours for 3 days.
  • Cease lens wear for 3-14 days.
  • Reassess patient later the same day or next.
  • Hygiene: Retrain proper hygiene and increase lens replacement frequency.

Question 17

Infiltrates and infiltrative keratitis

Answer 17

• Infiltrates & Infiltrative Keratitis:
  
  • Accumulation of white blood cells (WBCs) in the cornea.
  • Reaction to hypoxia, toxicity, allergy, trauma, or bacterial/viral toxins.
• Contact Lens (CL) Association:
  
  • Often associated with contact lens wear.
• Signs & Symptoms:
  
  • Discomfort, foreign body (FB) sensation, redness, tearing, mild photophobia.
  • Symptoms improve upon lens removal.
  • Single or multiple circular infiltrates (<1.0mm), dull, grainy, or hazy appearance in epithelium or anterior stroma.
  • Overlying epithelium does not stain.
  • Limbal or conjunctival hyperemia.
• Differential Diagnosis (DD):
  
  • Microbial keratitis (MK).
  • Adenovirus infection.
  • Contact lens peripheral ulcer (CLPU).
• Management:
  
  • Treat the underlying cause.
  • Cease lens wear until resolved (switch to daily wear lenses if necessary).
  • Reassess in 1 week.
  • Chloramphenicol if bacterial infection is suspected.

Question 18

Endothelial Bedewing

Answer 18

• Cause:
  
  • Can occur from oedema due to extended wear (EW) of contact lenses.
• Signs:
  
  • Small inclusions in central cornea.
  • Initially white but become pigmented.
  • Bilateral.
  • Reversed illumination (similar to microcysts).
  • Corneal clouding.
• Symptoms:
  
  • Stinging, red eyes.
  • Symptoms resolve in 3-5 days.
  • Bedewing (corneal changes) may take 3-5 months to resolve.
• Management:
  
  • Managed based on symptoms, not signs.
• Differential Diagnosis (DD):
  
  • Microcysts, which are not located in the endothelium.

Question 19

Endothelial Blebs

Answer 19

• Signs & Symptoms:
  
  • Black, non-reflecting areas within the endothelium.
  • Mosaic pattern.
  • Greater response with soft lenses vs. RGP lenses, thicker lenses, lower Dk.
  • Increase in number in late evening with extended wear (EW).
  • Patient typically asymptomatic.
• Prevalence:
  
  • Seen in 100% of contact lens wearers.
  • Observed within 10 minutes of lens insertion.
• Management:
  
  • Disappear within minutes of lens removal.

Question 20

Fuchs

Answer 20

Aetiology:
- Slowly progressive corneal endothelial dysfunction leading to corneal oedema and reduced vision.
- Resulting stromal and epithelial oedema causes epithelial bullae.
- Sporadic disease onset, commonly inherited.
- Cornea loses transparency, affecting BEs (Bruch’s membrane).

• Predisposing Factors:
  
  • 4th decade and older, rarely in 1st decade.
  • More common in females.
  • Smoking.

Symptoms:
- Glare & blur, especially upon waking (due to overnight oedema).
- Diurnal refractive changes, myopic upon waking.
- Sharp pain due to epithelial bullae rupture.
- Reduced contrast sensitivity.

Signs:
- Bilateral (can be asymmetrical).
- Affects central cornea, extending peripherally over time.
- Corneal guttata, creating a beaten metal appearance.
- Pigment dusting on the endothelium.
- Ground glass appearance due to cystic epithelial oedema.
- Increased corneal thickness (CCT), stromal oedema causing Descemet membrane folds.
- Posterior stromal scarring.

Management:
- Routine referral for diagnosis and CCT monitoring.
- Potential need for posterior lamellar transplant (DSAEK/DSEK/DMEK).
- Penetrating keratoplasty if necessary.
- May be combined with cataract surgery.

Question 21

Polymegathism

Answer 21

• Signs & Symptoms:
  
  • Decrease in cell density and regularity.
  • Cells become uneven in size.
  • In a 25-year-old, cell diameter ratio is 1:5.
  • In advanced cases with CL wear, ratio increases to 1:20.
  • Associated with corneal exhaustion syndrome due to loss of endothelial pump function.
  • Primarily an indicator of hypoxia, not really symptomatic.
• Prevalence:
  
  • Normal age-related change.
  • CL wear accelerates this change.
• Management:
  
  • Management is unclear, but it indicates metabolic stress.
  • Irreversible condition, leading to poor prognosis.

Question 22

Lipid deposits

Answer 22

• Lipid Deposits:
  
  • Causes a shimmering effect on the lens.
• Causes:
  
  • Lid margin disease (e.g., MGD).
  • Use of skin care products with oil before handling lenses.
  • SiH and Group II hydrogels lenses.
• Management:
  
  • Insert lens before using skincare.
  • Rub and rinse lenses with a surfactant solution (e.g., B&L Biotrue).
  • Treat MGD.
  • Consider daily disposables (DDs).

Question 23

Protein deposits

Answer 23

• Uneven Haziness on the Lens:
• Causes:
  
  • Fluorosilicone acrylates.
  • Tears, particularly protein buildup.
  • Some individuals may be more predisposed.
• Management:
  
  • Rub and rinse lenses.
  • Use Amiclair protein remover.
  • Consider daily disposables (DDs).
  • Treat dry eye.

Question 24

Similarities in staining treatment

Answer 24

• Cease lens wear for X number of days
• Switch to DDs
• Refit with different WC, Modulus, DK, Material
• Reduce WT
• Ocular lubricants

Question 25

Toxicity staining

Answer 25

- **Corneal Damage from RGP Cleaner/Peroxide Solution**: **Cause**: - **Hydrogen peroxide**: If lenses are not properly neutralized, peroxide can damage the cornea. - **RGP cleaner**: Not thoroughly rinsing cleaner can cause irritation (like shampoo in hair, needs proper rinsing). **Symptoms**: - Stinging, burning, vision drop (if severe). **Differential Diagnosis** (DD): - **Deposit staining**: Mucin balls (appear more localized, not as diffuse). - **Dry eye**: Less likely with annular pattern, depends on when symptoms occur. **Management**: - **Cease lens wear** for a few days. - **Reteach cleaning procedures**: Use enough saline after RGP cleaner, neutralize hydrogen peroxide properly. - Patient can rinse lenses with saline or switch to **daily disposables (DDs)**.

Question 26

3 and 9 oclock staining

Answer 26

- **Lens Vaulting and Dryness**: - Lenses are **vaulting the eyelids** at certain points, causing areas of dryness on the eye due to improper tear supply. - **Cause**: - **Incomplete blinking** or **lens design** issues (centring and how it sits on the eye). - **Differential Diagnosis (DD)**: - **Pingueculas**: Do not stain the cornea, and are noticeable. Do not involve the cornea. - **VLK (Vernal Keratoconjunctivitis)**: Would extend from the conjunctiva onto the cornea, with additional symptoms. - **Management**: - **Improve centration**: Use larger **total diameter (TD)** or **thinner edge designs**. - For **>2D astigmatism**, consider **toric RGP** lenses. - If **RGP doesn't work**, switch to **SiH** (silicone hydrogel). - Use **ocular lubricants** to relieve dryness.

Question 27

SICS Staining (Solution Induced Corneal Staining)

Answer 27

- **Symptoms**: - **Mild stinging & burning** on lens insertion. - **Staining**: Annular punctates or diffuse. - **Management**: - **Cease lens wear** for 2-3 days and use **ocular lubricants**. Rereview afterward. - Use **solutions without added preservatives**, such as hydrogen peroxide. - **Rinse lenses with saline** before insertion; rubbing lenses with the preserved care product before storage may reduce SICS (solution-induced corneal staining). - Select **SiHy lenses** and disinfection solution combinations that are known to cause less solution-related staining. - Consider switching to **daily disposable lenses (DD)**. - **Asymptomatic or mild cases** may not require treatment.

Question 28

FB

Answer 28

- **Cause**: Epithelial abrasion from foreign body under lens, damaged lens, makeup brush, or incorrect insertion/removal techniques. - **Management**: - **Examine upper lid** in different directions to check for foreign body (FB). - **Remove FB** if present. - **Stop contact lens wear** for a day. - Use **green Hycosan drops** every 2 hours to promote healing. - **Recall after a day** for re-evaluation. - Advise wearing **sunglasses** for extra protection. - **Replace damaged lens** and **re-teach insertion/removal techniques**. - Consider **topical prophylactic treatment** if more severe.

Question 29

SEAL (Superior Epithelial Arcuate Lesion)

Answer 29

- **Cause**: Friction between contact lens (CL) and eye, causing corneal epithelium damage due to lens thickness. - **Signs & Symptoms**: - Mild discomfort. - Superficial arcuate staining of the superior cornea, between 10 and 2 o'clock, parallel to the limbus. Typically unilateral and asymmetric. - **Management**: - If associated with extended wear (EW), **monitor closely** until resolution. - If more severe, **cease lens wear** and use **rewetting drops**. - If symptoms persist, **refit to daily disposable lenses**, a **higher water content lens**, a more **aspheric back surface**, or a **lower modulus material**.

Question 30

Smile Stain

Answer 30

- **Cause**: Multiple potential causes such as incomplete blinking, lens dehydration (especially with high water content lenses), dry environment, etc. - **Signs & Symptoms**: - Inferior arcuate staining of the inferior cornea, between 4 and 8 o'clock, parallel to the limbus. Often bilateral and asymmetric. - **Management**: - **Cease lens wear** temporarily (if severe), using **wetting drops**. - If symptoms persist, **refit with a lower water content lens** or **Silicone Hydrogel (SiH)** lenses, or consider **reducing wear time**. - Increase **humidity** to reduce dryness.

Question 31

Dimple Veiling

Answer 31

- **Cause**: Indentations of the epithelium due to air bubbles (rigid lenses) or mucin balls (soft lenses) trapped under the lens. - Most frequently seen with ill-fitting **steep GP lenses** (air bubbles) or **SiHy lenses** (mucin balls). - In **GP lenses**, observed centrally with excessive pooling and peripherally with excessive edge lift. - **Management**: - **Refit GP lens** with closer alignment to the corneal shape: - Flatter **Back Optical Zone Radius (BOZR)**. - Smaller **Total Diameter (TD)** to reduce sag. - Reduce **edge lift**. - Consider changing to a **toric back surface**. - For **SiHy lenses with EW**, use **lens lubricants**. - Choose a lens with **lower modulus** for better comfort and fit. - **Diagnosis**: Likely caused by the lens being **too steep**.

Question 32

Mucin Balls

Answer 32

- **Cause**: Friction from the lens due to its thickness impedes onto the front of the eye, causing tears to condense/breakdown and form underneath the lens. - **Spheroidal**, refractile particles under a contact lens, most common in the **superior region** and under the upper eyelid. - **Non-reversed illumination** in marginal retro illumination. - Most particles disappear upon **lens removal**, but some remain briefly. **Vacuoles & microcysts** may take longer to resolve. - Typically observed with **EW (Extended Wear)** and **SiH (Silicone Hydrogel)** lenses. - **Management**: - **Monitor** the condition. - Only change the lens if **comfort is affected**. - **Lubricating drops** can help manage symptoms.

Question 33

General Signs of hypoxia

Answer 33

- Chronic corneal oedema leading to... - Microcysts: - Must DD between microcysts & vacuoles. Vacuoles show non reversed illumination, are larger & more rounded - Vacuoles Vs Mucin balls - vacuoles come after a while & don’t leave after lens removal but mucin balls do. Vacuoles more chronic hypoxia related. - Reversed vs Unreversed indicates which side the shadow is cast as seen below in the picture. - Limbal hyperaemia - Neovascularisation - Hazy, blurred vision. Stromal striae, folds, haze - Changes in Rx - typically slight myopic shift - Polymegathism

Question 34

Management for Hypoxia

Answer 34

Change to high Dk/t lenses, reduce the number of nights wear/week if EW, or change to DD

Question 35

Aftercare - Routine & Other issues

Answer 35

Routine - H&S > OR > Fit > Remove CL (px removes, you watch) > Anterior eye (lid eversion) + NaFl > Advice THERE IS A SECTION ON THIS! REVIEW!

Question 36

Advice

Answer 36

Recall /12. Px on scheme, will carry on. Carry on with current solution + lens, Fit + VA good. Advised wash & dry hands before I+R, inspect lens for chips/debris/right way round, empty prev solution, rinse with solution & air dry facedown on tissue. Rub & rinse on removal with solution, fill case with new sol. every removal. Dont get water in lens (swim/tap) or sleep/nap in lens or wear for >10hrs. New case + lens every 1/12. If eyes red/painful/blurry/photophobic cease wear & contact us (A+E if we're out of hrs). Any issues return sooner.

Question 37

Assessor will ask about what tear prism height & TBUT is:

Answer 37

- Tear prism height (NON INVASIVE, MEASURES AQUEOUS DEFICIENCY) → inferiorly, the tears make up 75-90% of tear volume so this is measured to have a good basis for level of tear secretion. Normal is between 0.2-0.3mm. If less than 0.18mm then dry eye. - Best to do under minimal illumination, not directed at pupil otherwise you will cause lacrimation. Best to do without NaFl as this increases the prism height - TBUT (INVASIVE, MEASURES EVAPORATION + AQUEOUS DEFICIENCY)→ >10 secs normal, 5-9 secs borderline, <5 secs dry eye. Looks at how quickly the tear film thins, destabilises & evaporates as a result.