SCL Complications Flashcards
Physical causes of complications
CL
- fit
- condition
- design
Blinking
-blinking
-lid tonus
Causes of visual complications
- current Rx
- presbyopia
- binocular vision
Wearer relates causes
- non compliance
- failure to attend appointments
Physiological causes
- Dk
- water content
- environment
- blinking
Pathological causes
- microorganisms
- condition of case
- chemical
- immunological issue
- environment
- existing pathology
Steps to prevent complications
- px selection
- px education
- lens selection
- aftercare + intervention
1: Epithelial microcysts
- related to Dk/t & wear modality
- delayed onset = 2/3 months
- common in EW lenses
- low cyst count regarded acceptable
Risk factors:
- corneal dystrophy
- anterior eye infection
- chronic hypoxia
Symptoms:
- asymptomatic
Signs:
- small round dots, vary in number
- reversed illumination
- only seen when breaking out of epithelium with NaFl
Management:
- monitoring
- reduced CL wear time
- 3 month recovery
- cease EW
- increase CL Dk/t
- change to RGP
2: Corneal Vascularisation
Aetiology:
- hypoxia
- corneal oedema
- epithelial injury
- infection
Management:
> corneal O2 supply: Dk/t> / SiHy / refit with GPs
Optimise CL fit
< wear time
- removal of stimulus
- increase corneal O2 supply
- early intervention vital to prevent new vessels
- ghost vessels remain unless early intervention
- close monitory when cl wear resumed
3: Corneal Infiltrates
- epithelial/sub-epithelial/stromal
- discrete collections of inflammatory cells
- outlying epithelium is intact
- maybe sterile or infected
Aetiology:
- bacterial presence
- poor hygiene
- tight CL
- hypersensitivity
- CL deposits
- hypoxia
- mechanical trauma
Appearance:
- may be focal/arcuate/diffuse
- hazy, greyish-white
- tiny + circular to a wholly appearance
- epithelial/sub-epithelail/stromal
4: Infiltrative Keratitis
Symptoms:
- asymptotic to painful
- Cls can mask problems
- FB sensation
- Photophobia
Signs:
- can be bilateral
- Periphery to mid-periphery
- anterior stroma
- no oedema
- no AC reaction
- small infiltrates
- slight staining
-moderate limbal redness
Management:
- cease CL wear
- monitoring
- antibiotics/artificial tears
- px education
- refit with SiHy + dailies
- resolution necessary before CL resumption
5: Asymptomatic Infiltrative Keratitis
- infiltration of cornea with no symptoms
- small infiltrates
- peripheral
- similar management to IK
6: Corneal Staining
Symptoms:
- FB sensation
- irritation/grittiness
- excessive lacrimation
- reduced CL wear time
Management:
- rewetting drops
- refit
- reduce WT
- treat underlying condition
7: Epithelial abrasion/erosion
- significant abrasion causes disorganised epithelium
Aetiology: mechanical
- finger nail
- CL defect
- trapped FB
Symptoms:
- mild/severe pain
- photophobia
- lacrimation
Signs:
- bulbar redness
- dense localised staining
- stromal infiltrates
Management
- check for FB
- treat as MK
- prophylactic antibiotics
- avoid corticosteroids
- Monitor px
8: CL induced papillary conjunctivitis CLIPC
- Giant papillary conjunctivitis
- usually from SCL
Aetiology:
- front surface deposits
- immune response
- mechanical irritation
- drying of CL surface
Symptoms:
- early asymptomatic
- increased lens movement
- increased CL awareness
- CL intolerance
- increased mucus effects drying
- itching
Signs:
- enlarged papillae >1mm
- palp hyperaemia
- ptosis if chronic
- roughened appearance (cobblestone)
- tissue oedema
Mangament:
- modify CL wear
- pharmacological therapy
- px education
- optimise CL care
- more frequent replacement
9: CL Wrinkling
Aetiology:
- minus of plus BVP
- low water material
- lid forces
Symptoms:
- rapid onset
- reduced vision
- quick recovery
Management:
- change CL design
- thicker design
- SiHy CLs
- GP lenses
- increase water content
- consider more rigid material
