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4 Contact Lens > Lec 5 RGP complications > Flashcards

Lec 5 RGP complications Flashcards

(51 cards)

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1
Q

Complications of tight RGP lens

A

Lens peripheral seal off so less tears/Lens adhere to cornea binding

Corneal indentation

NaFl staining outlining CL

Staining next to lens edge from rubbing

Central bubble/Cluster (dimple veil)

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2
Q

Symptoms of tight RGP

A

Lens discomfort

Ocular redness

Difficulty removing

Bubbles decreasing VA

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3
Q

How to treat tight RGP

A

Increase BC radius

Increase peripheral curve - edge lift

Widen peripheral curve

Decrease optic zone size

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4
Q

Complications of flat and loose RGP

A

Lens edge staining “jarring” on conjunctiva as motion

Central NaFl staining as motion

Draws in debris/FB/mucous under lens

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5
Q

Symptoms of flat and loose RGP

A

Lens discomfort and awareness

High lens dislodging rate

Visual fluctuation

High frequency of trapping FB and discomfort

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6
Q

How to treat loose RGP

A

Decrease BC radius

Decrease peripheral curve radius so increase edge lift

Decrease peripheral curve width

Increase optic zone diameter with lens diameter increase

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7
Q

Complications of high edge lift

A

Peripheral NaFl staining

FB tracking

Bubbles sucked under lens

Lens dislodges

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8
Q

Symptoms of high edge lift

A

Lens discomfort and awareness

High dislodging rate

Thing strapped under eye like dust

Lens moves too much

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9
Q

Treatment for high edge lift

A

Decrease peripheral curve radius so edge lift

Decrease peripheral curve width

Customise peripheral curves

Use toric periphery if excess edge lift in one meridian

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10
Q

Cause of dimple veiling

And sign

A

Steep central or high edge lift trapping bubbles and act as solids causing pits in epithelium

Pools NaFl

Irregular topography

Decreases vision if central

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11
Q

Treatment for dimple veiling

A

Decrease clearance by secreasing sag centrally or decrease edge flirt

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12
Q

Signs of Corneal insult/FB Tracking/Incidental abrasion

A

Localised corneal staining linked to cause

Material trapped behind lens

Injury direction to cornea

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13
Q

Symptoms of Corneal insult/FB Tracking/Incidental abrasion

A

Acute lacrimation

Discomfort till FB dislodged

Discomfort till cornea near healed

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14
Q

Etiology of Corneal insult/FB Tracking/Incidental abrasion

A

Lens mobility moves FB around under lens

Greater edge clearance means greater chance of getting FB under lens

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15
Q

Management of Corneal insult/FB Tracking/Incidental abrasion

A

Stop CL wear temporarily for min to hrs - recovery within hrs if superficial

Irrigate if multiple FB in eye - check lid

Prophylactic broad spectrum AB for deeper abrasions

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16
Q

Signs of corneal warpage from constant high or low riding CL

A

Corneal topography distorted so irregular astig so dec VA

Acuity with CL better than specs

Lens positioned high or low on eye and indentation pattern

Possible oedema

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17
Q

Symptoms of corneal warpage from constant high or low riding CL

A

Asymptomatic (masks)

Complains spec vision not good

HX shows no ownership of any glasses

Long hours wearing CL

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18
Q

Findings for corneal warpage

A

Distorted keratometry mires

Irregular retinoscopy results

Indecisive subjective refraction

Reduced BCVA in spectacles +spec blur

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19
Q

How to manage corneal warpage

A

Change lenses with increased transmissibility OR stop CL

Repeat refraction and topography every 1-2wks till changes stabilise

Slowly withdraw original lenses and fit with softer lenses and FINAL Refit with improved lens centration and more 02

SPECIAL TALK!

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20
Q

What’s the SPECIAL TALK for corneal warpage management

A

Need to convince them they need to change

Ensure they have updated glasses to prevent heavy reliance on CL

Let them know the new CL uncomfy as corneal sensitivity returns

RESIST request to return to old lens haha

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21
Q

What’s the cause of 3&9 o’clock staining (peripheral corneal staining)

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A

Lens edge meniscus and local tear film thinning

22
Q

What’s lens bridging

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A

When the eyelid gets lifted away from the globe creating a vacuum so dries out an area creating staining in outer portions

23
Q

What are some factors for 3 and 9 o’clock staining

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A

Reduced blink rate, partial blinker, poor tears

Long CL hours, CL wettability

CL thick edge/edge defect

Excess clearance as dries out neighbouring area OR low edge clearance as digs

24
Q

How to treat 3&9 o’clock Staining

Study These Flashcards
A

Patient education

Tear supplements/Improve blinking

Redesign lens to improve fitting

Maximise lens wettability and minimise surface deposits

25
What’s Dellen
Localised thinning of cornea in saucer like depression that pools with NaFl Happens due to paralimbal elevation causing a break in precorneal oily tear layer so dehydrated and thins
26
What contributes to dellen
Elevations (ping/ptery/RGPedge) Chronic tear film evaporation Post operation (IOL implant/subconjunctival injection/bleb surgery) Chronic 3 and 9 o’clock staining
27
How to manage dellen
Stop RGP temporarily to allow reepithelisation and corneal thickness to return Lubricate Manage cause
28
Whats vascularised limbal keratitis
Opaque elevated mass at nasal/temp cornea next to limbus due to mechanical insult from RGP edge SO usually from large diameter lens with low edge lift
29
What’s RGP induced ptosis
Lowering of upper lid to reduce the palpebral aperture over time in an RGP wearer with associated swollen red lids
30
Common causes of RGP induced ptosis
Lid traction during lens removal Mechanical interaction of lid riding over the lens Inflammation
31
How to treat RGP induced ptosis
Stop CL wear for 4-12 weeks Refit with SCLs Review lens edge profile to be more thin and tapered Lid surgery
32
What are the main CL integrity problems
Lens curvature warping Edge defect/sharpness Front surface issues - scratches/deposit adherence/poor surface wetting
33
Signs of lens warping
NaFl pattern of CL weird Vision reduced BC readings abnormal and mires didn’t focus on a single point BVP differnt than original
34
Causes of lens warping
Heavy handling Cleaning between thumb and forefinger Pressing lens against lens case Along it to dry out with solution residue
35
Management of lens warping
Verify using radisucope Replace lens -can make it thicker/stronger Re-educate in handling
36
Signs of edge defect/sharpness
Can see defect of lens edge Tactile rim feels sharp Lens rip poorly rounded Conjunctival jarring staining
37
Management of edge defect/sharpness
Polishing rolling of lens edge Increasing thickness if edge thin Ordering new lens if significant defect
38
Signs of front lens surface issues
Scratches Crazing Lens surface non wetting so patchy dry surface Deposits
39
Sources that cause non wetting on a Cl
Over polished surface High wetting angle material Contamination with lanolin Old CL
40
Complications with lens surface issues
Increase risk for bacterial adhesion as now surface irregular Increase risk for conjunctival surface irritation as eye lid blinks over irregular surface Discomfort and stop wearing lens Risk for staining and redness
41
What’s lid wiper epitheliopathy
Upper lid is subjected to higher then normal frictional force due to lack of tears OR lens surface with high coefficient of friction
42
What’s CL Induced Papillary Conjunctivitis | CLPC
Commonly due to mechanical irritation of lens causing inflammation of superior tarsal conjunctiva = large papillae
43
Process of papillae formation in CLPC
Antigen in CL causes vessel changes/hyperaemia Basophils and mast cells accumulate and release ECF-A that attracts eosinophils Eosinophils release histamine causing itch, erythema and edema
44
Compare structure between papillae and follicles
Papillae in CL wear but follicles not related Papillae cobblestone like/hyperaemic with central vascular tuft BUT follicles translucent pale elevated rice grain shaped and avascular Papillae 0.3-0.9mm follicles are 0.2-2mm Papillae superior palpebral conj VS follicles inferior
45
Papillae VS follicles physiology
Papillae chronic VS follicles not papillae seen in normal conj VS follicles not seen normally Papillae mainly inflammatory cells VS follicles are local aggregation of lymphocytes Papillae mucus strands VS follicles Not
46
Management of CLPC
Stop/minimise wear Manage cause e.g thinner lens, deposit care, replace lens, edge shape, overwear Therapeutics like histamine blocker, MCS, combo stabiliser and antihistamine, mild steroid if more chronic
47
Sources of infiltrates
Bacterial toxins Tight lens Trauma Eye closure with lens Poor hygiene e.g hand wash after smoking Poor disinfection
48
What are sterile infiltrates
Inflammatory cells that migrate from limbal BVs
49
What’s solution toxicity/hypersensitivity
Ocular surface exposed to chemical agent in CL solution that’s toxic to epithelial causing diffuse staining over cornea and acute or chronic redness
50
Common causes of solution toxicity or hypersensitivity
Mercury based thimerosal Chlorhexidine Benzalkonium chloride Changing solutions recently
51
Management of solution toxicity
Remove CL Irrigate Change solution to diff preservative

4 Contact Lens (11 decks)

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