Flashcards in CL 2-8: GP Lens Complications Deck (56):
Fit Related Complications (6)
2. Corneal Edema
3. Corneal Warpage
4. Central Staining
5. Dimple Veiling
6. 3 and 9 Staining
Dimple Veiling (1)
a. Poor Fitting relationship b/w what?
b. Indentations are formed by AIR BUBBLES that are trapped b/w what?
c. FORMS IN AREAS of what?
d. Can also be due to the use of what?
1. a. b/w Lens-Cornea
b. b/w Back Surface of Lens and Epithelium
c. of EXCESSIVE POOLING
d. to the use of Aerosol Saline
Dimple Veiling (2)
1. Is it true corneal staining?
2. How does it resolve?
3. May interfere with what?
4. What do we need to look at?
5. How do you MANAGE IT?
2. by removing the lens
3. with Vision
4. Look at the Fit AND Patient's Symptoms to decide whether a change is needed.
5. Adjust Fit to REDUCE POOLING in are of Dimple Veiling
Binding/Lens Adherence (1)
2. You get thinning of what?
a. Especially during what?
b. Occurs in what % of Patients in GP LENS EXTENDED WEAR?
1. Lens-Cornea Adherence in the ABSENCE of Lens movement with blink. (SUCTION EFFECT)
2. thinning of post lens tear film
a. esp. during sleep
b. in 50% of Patients in GP lens EW.
Binding/Lens Adherence (2)
1. Lenses bind/Adhere due to what?
a. 2 Places this can happen?
1. due to insufficient tear flow.
a. tear flow can be impeded in the PERIPHERY or in the MID-PERIPHERY
Binding/Lens Adherence (3)
1. Major Clue that a Lens is bound?
2. What other 2 things are clues?
1. NO MOVEMENT!
2. a. Areas of Heavy bearing where TEARS are COMPLETELY ABSENT!
b. Tear exchange could be cut off in the Periphery or Mid-Periphery
Binding/Lens Adherence (4)
a. Improve what?
b. If LENS is TOO STEEP?
c. If BC is OKAY, but the PERIPHERAL SYSTEM is TOO TIGHT, what do you do?
1. a. improve tear exchange
b. FLATTEN the BC. (All peripheral curves will be flattened as well)
c. LOOSEN the Peripheral Curves
Central Staining (1)
1. Type of Lens that causes this?
2. What is occurring b/w this lens and the Cornea that causes central staining?
1. Flat Fitting Lens
2. Mechanical Force of LENS AGAINST the APEX of the Cornea ERODES the Corneal Surface
3 and 9 Staining (1)
1. Corneal staining where?
a. Caused by what?
b. Why is it important to know about it?
1. in the peripheral Cornea at 3 o'clock and/or 9 o'clock position
a. DESSICATION associated w/GP CL Wear
b. cuz it's the MOST PREVALENT COMPLICATION of GP CL Wear
3 and 9 Staining (2)
3. Patient Symptoms?
1. Superficial Microerosions of the Corneal Epithelium JUST LATERAL to CL EDGES!
2. INADEQUATE CORNEAL WETTING!
3. Usually none, but could be MILD IRRITATION, or Localized Conjunctival Injection
3 and 9 Staining (3): Management
1. Aimed at Specific Cause
a. Treat what?
b. Improve what on CL?
c. what else can be IMPROVED?
d. How can you IMPROVE EDGE DESIGN?
1. a. Treat DES and/or MGD
b. Lens movement if insufficient
c. CENTRATION so PERIPHERY of LENS is ALIGNED to the PERIPHERY of the CORNEA (Low riding lenses especially)
d. Decrease Edge Thickness and Change Peripheral Curve Radius/Width to either Increase or Decrease Peripheral Clearance
3 and 9 Staining (4)
So what can cause it?
1. Periphery of Lens is NOT aligned w/Periphery of Cornea
2. Insufficient Edge Clearance can lead to 3 and 9 staining
as well as Excessive Edge Clearance
3 and 9 Staining (5)
1. Long term Complications of 3 & 9 Staining: (Chronic/Severe cases can lead to what 3 things?)
1. Vascularized Limbal Keratitis (VLK)
3 and 9 Staining (6)
a. What is it?
c. 4 major signs?
d. 5 Major symptoms?
1. a. Inflammatory Complication Unique to GPs
c. Corneal Vascularization; Localized Conjunctival Injection; Semi-opaque Epithelial Elevation; Surrounding Tissue Stains with NaFl
d. Cosmetic concern; Lacrimation; Lens Awareness; Lens Discomfort; Photophobia
3 and 9 Staining (7)
1. Management of VLK
a. Improve fit using what?
b. What topical can reduce Redness?
c. What topical may reduce inflammation?
1. a. using Guidelines for 3&9 Staining
b. Topical Decongestants (Rebound Redness)
c. Topical Corticosteroid (Not a Long-term solution)
3 and 9 Staining (8)
a. It's a Localized Excavation of the Cornea near what?
b. Local Dehydration of the STROMA leads to what?
c. Can occur as a result of what 3 things?
1. a. near the Limbus with Intact Overlying Epithelium
b. that leads to a Compression of its Lamellae
c. of Surgery, Swelling of the Limbus (like in Episcleritis or Pterygium), or due to AGING
Corneal Warpage (1)
1. Relative Flattening of Cornea underlying what?
a. High Riding Lenses = ?
b. Low Riding Lenses = ?
c. This can occur with what type of CL?
1. the Resting area of the CL.
a. Superior Flattening (Keratoconus-like Pattern)
b. Inferior Flattening
c. any type of CL (more common w/GPs)
Corneal Warpage (2)
1. Symptoms (1)?
2. Signs (4)
1. Spectacle Blur
2. a. Corneal Cyl does not equal Refractive Cyl
b. Decreased Myopia
c. Distorted Keratometry Mires
d. Topographic Changes (Corneal Flattening, Irregular Astigmatism)
Corneal Warpage (3)
a. Main thing to do?
b. GP Warpage takes how long to Normalize?
c. CAUTION with what?
d. Repeat Topography how often?
1. a. DISCONTINUE CL WEAR!
b. about 10 wks to normalize (but can take up to 6 months)
c. with Refractive Surgery!
d. every 2-4 weeks
Corneal Warpage (4)
1. Differentiating Warpage and Keratoconus: KERATOCONIC EYES Have what 5 things?
2. Corneal Warpage: On Topographer can have what?
1. a. Greater Corneal Toricity
b. Posterior Elevation Map Changes (Orbscan, Pentacam)
c. Slit lamp signs of the disease (usually)
d. Steeper K Values
e. Thinner Corneal Pachymetry
2. can have an INFERIOR "Smile" Pattern
Corneal Edema/Central Corneal Clouding (CCC) (1)
1. Corneal Edema Secondary to what?
a. What 4 things can cause this?
2. 4 Major Symptoms?
1. to Chronic Hypoxia
a. Insufficient Tear Exchange, Lens overwear and/or EW, Low Dk Material, Thick Lens
2. a. Haloes
c. Spectacle Blur
d. Stinging, Burning, Pain
Corneal Edema/Central Corneal Clouding (CCC) (2)
1. Differential Diagnoses for Corneal Clouding? (7)
1. Birth Trauma
2. Congenital Hereditary Endothelial Dystrophy (CHED)
3. Dermoid Tumors
4. Infectious/inflammatory Processes
6. Peters Anomaly
Corneal Edema/Central Corneal Clouding (CCC) (3)
1. Refit into what kind of Dk Material?
2. Increase/Decrease CL wear time?
3. What about EW?
4. Increase/Decrease Lens thickness?
5. Adjust fit to allow for what?
1. a HIGHER Dk Material
4. DECREASE (use High Index Material)
5. for better tear exchange (Peripheral System)
Endothelial Changes in CL Wearers
1. Chronic what?
2. Accumulation of what can cause Corneal Swelling?
3. Long term?
4. Causes (3)?
1. Chronic Hypoxia
2. of CO2 and Lactate Lowers pH of Endothelium, causing Corneal Swelling
3. Pleomorphism (change in cell shape) and Polymegathism (increase in cell size)
4. a. EW Schedule
b. Excessive Wear Time
c. Low Dk Materials
Complications Not Generally related to Lens Fit (7)
1. CL Warpage
3. Corneal Abrasion
5. Lens Cracking/Crazing
6. Foreign Body Tracking
7. Microbial Keratitis
CL Warpage vs. Flexure
1. Warpage = ?
a. May be caused by what?
2. Flexure = ?
1. Permanent Alteration in CL shape over time
a. May be cause by Flexure over time
2. Lens Flexes/Bends/Conforms when on the eye.
1. What are the CAUSES of FLEXURE? (5)
2. High Dk Material
3. Highly Toric Cornea
4. Thin Lens
5. Tight Lid
Signs of Flexure
1. Flexure occurs in what meridian?
2. Lenses can flex up to what % of Corneal Toricity?
1. in the STEEPEST CORNEAL MERIDIAN
2. up to 30%
1. You will get a Cylindrical Over-refraction:
a. If a GP Lens Flexes on an ATR Cornea, the Over-refraction will do what?
b. If a GP lens flexes on a WTR cornea, the Over-refraction will do what?
1. a. INCREASE the ATR Cylinder by the amount of Flexure
b. Increase the WTR Cylinder by the amount of Flexure
1. We Expect a GP to maintain its form and create what?
2. With flexure, the GP lens conforms to the cornea, creating what?
1. and create a tear lens b/w Rigid CL material and Cornea
2. Creating less of a tear lens than expected if the CL maintained its rigidity
Flexure can be desirable or undesirable
1. It's Desirable if what?
2. It's undesirable if you're not getting what?
1. if you DONT need the Tear lens to provide power
2. if you're not getting the tear lens you were relying on to provide the right power
1. Spex Rx = -1.00 DS
2. K Values = 44.00/45.00 @ 175
3. IF this patient's lens flexes by ANY MAGNITUDE, what will happen?
4. If the Lens flexes a FULL 1.00 D, then what will happen?
3. it will DECREASE the Tear Lens, Decreasing the CRA
4. then there will be NO CRA.
Management of Flexure
1. What 3 things can be done to manage it?
1. Increase CT
2. Discontinue EW
3. Use Lower Dk Material
1. Lens shape is changing ONLY WHEN the LENS is where?
a. This MAY OR MAY NOT lead to what?
1. is ON THE EYE
2. to a permanent change in lens shape
1. Lens shape has been PERMANENTLY altered through Continued pressure on the Lens due to what? (6)
1. a. EW
b. Excessive Digital Pressure during cleaning
c. High DK Material
d. Highly Toric Cornea
e. Tight Lid
f. Thin Lens
Signs of Warpage
1. How can you tell through a RADIUSCOPE?
2. Unable to get what in focus at the same time in the Radiuscope?
3. May get a small amount of what on the Lensometer?
4. How do you manage Warpage?
1. 2 BCRs on radiuscope, but roughly Spherical Power on Lensometer
2. unable to get all of the SPOKES in focus at the same time.
3. of Toricity/Distortion on the lensometer
4. Order a NEW LENS!
1. Mainly what?
2. SA --> ?
3. FSA --> ?
1. Protein/Lipid deposits
1. 3 ways to manage it?
3. Switch Solution or Regimen
Deposits (3): Menicon Progent
1. What is it?
a. What does it remove?
b. What does it kill (5)
c. What 3 things does it Deactivate?
2. Ampule A = ?
3. Ampule B = ?
4. How do you get it to work?
5. Recommended use?
1. In-Office GP "Super Cleaner"
b. Acanthamoeba, Bacteria, Mold, Yeast, and Viruses
c. Bovine Rotavirus, HSV 1, and Adenovirus 5
2. Sodium Hypochlorite
3. Potassium Bromide
4. Mix and Swirl, 30 min soak, and No hand polish
5. Every 2 wks. (now available w/saline vials for pt use at home)
CL Related Papillary Conjunctivitis (CLPC) (1)
2. Uni/Bi lateral?
3. type of Mediated Inflammation?
4. Mechanical vs. Chemical antigen (4)
4. a. Deposits
b. Lens Material
c. Predisposition of Atopic Pts
CL Related Papillary Conjunctivitis (CLPC) (2)
1. GPC Associations (6)
1. CL wear (SCL > GP, SiHy > Hydrogel)
2. Corneal Scars
3. Exposed Sutures
4. Glaucoma Filtering Bleb
5. Lens Deposits
6. Prosthetic Device Wear
CL Related Papillary Conjunctivitis (CLPC) (3)
1. Symptoms (5)
1. CL may be uncomfortable (other times eyes feel more comfortable w/CL)
2. FB Sensation
3. Increased CL movement
5. Mucus Discharge
CL Related Papillary Conjunctivitis (CLPC) (4)
1. Signs (5)
1. Epithelium Thickening
2. Giant Papillae (1-2 mm in size)
3. Increased CL Movement
4. Ropy Mucus Strands
5. Superior Tarsal Conjunctival Hyperemia
CLPC in Gps vs. SCL
1. SCL wearers tend to get giant papillae first at what area?
a. These then progress towards what?
2. GP lens wearers first get papillae near what?
1. at the LID FOLD
a. TOWARDS the LID MARGIN
2. NEAR the LID MARGIN and CENTRAL PALPEBRAL CONJUNCTIVA
Stages of GPC: 4 Stages
1. Preclinical Stage with what?
2. Conjunctival Hyperemia and Thickening with what?
3. Formation of what?
4. Formation of what?
1. with MILD increase in Mucus Production
2. with Slight Elevation of Papillae
3. of Larger Papillae from Coalescent Smaller Papillae
4. of Elevated, Giant Papillae with Flattened Heads. These may STAIN with NaFl.
CL Related Papillary Conjunctivitis (CLPC) (5)
2. What Topical Combo can be used?
3. What other Topical can be used?
1. reduce and eventually eliminate signs and symptoms of Hyperemia, itching, mucus discharge and CL intolerance
2. Topical Anti-Histamine/Mast Cell Stabilizer Combo
3. Topical "soft" Steroid
CL Related Papillary Conjunctivitis (CLPC) (6)
Long Term Management with GPs
1. Deposit management through the use of what?
2. What else (4)
1. thru use of Enzymatic Cleaners
2. a. Switch Solutions
b. Rub Lenses
c. 10x's less GPC w/GP vs. SCL
d. May need to stay on Topical Anti-histamine/Mast Cell Stabilizer Combo
Foreign Body Tracking (1)
1. Causes (2)?
1. Foreign Body trapped under the lens
2. Lens Deposits
Foreign Body Tracking (2)
1. Signs? (2)
2. Symptoms (3)?
1. Appear as ZIG-ZAG Lines, usually VERTICAL. and Highlighted with NaFl
2. Possible Pain, FBS, and Lacrimation
a. Check for debris trapped under lens or eyelid
b. Asymptomatic or Mild Discomfort once Foreign Body or CL itself is removed
Foreign Body Tracking (3)
1. Remove Offending agent...
2. What else can help?
3. If severe, consider what?
1. FB, Deposits (polishing, Tx with Progent or New Lenses)
2. Artificial Tears
3. maybe use Prophylactic Topical Antibiotic
Corneal Abrasion (1)
1. What is it?
2. CL Related?
3. May have what associated with it?
1. Defect in the Epithelium of the Cornea
2. usually due to lens removal (nails, or DMV)
3. Subconjunctival Hemorrhage
Corneal Abrasion (2)
1. Signs? (5)
1. Conjunctival Injection
2. Epithelial Defect that stains with NaFl
3. Mild AC Reaction
4. Mild Eyelid Edema
5. (-) Seidel's Sign **
Corneal Abrasion (3)
1. DDx (3)?
1. Corneal Ulcer
3. Confluent Punctate Epithelial Keratitis (PEK)
Corneal Abrasion (4)
1. Symptoms (5)
1. Pain ** (relieved w/Proparacaine)
5. H/O Scratching or Something hitting the eye
Corneal Abrasion (6)
1. Treatment (2)
2. Antibiotic: Drops or Ointment (3 of them)
3. Pain Control (4 things)
1. a. Debride any Loose tissue/loose edges
b. Artificial Tears
2. a. Erythromycin ung qhs
b. Polytrim QID
c. Vigamox or Zymar QID
3. a. Cycloplegic (5% Homatropine BID)
b. Patch or Bandage CL (not if they're a CL wearer)
c. Topical NSAID (Nevanac, Acular, Xibrom)
d. Oral Pain Killers (Lortab, Vicodin)