wk2: CL/M - CL Prelim Exam Lens application/removal Flashcards
Come up with some important history questions to ask a patient who wants contact lenses? (9. Based on student responses, I picked the good ones)
What are they for? (e.g. cosmetic) How often will you wear them? Have you tried CLs before? Have you had any eye infections? Do you wear glasses? Do you have dry eyes? Do you work in an environment with lots of dust? Visual requirements? Sore/itchy, alergies, lazy eyes, injuries, medications
What are the 3 basic key aims/objectives of a preliminary examination for a patient who wants contact lenses?
- inform patient to set expectations
- assess px suitability
- obtain baseline information
What considerations should you inform your patient (who wants to get CLs) of? (5)
Time taken in clinic (incl. fitting sessions and fitting fees)
expense
Types of CLs
Need for aftercare visits
Need for CL special storage + maintenance
Adaptation
What factors can influence suitability for CLs? (4)
Motivation
Ocular indications/contraindications
Personal indications/contraindications
Systemic factors
What personal indications are there for CL suitability? (5)
Cosmetic reasons Highly motivated px Sport Occupation Large refractive error
What personal contraindications are there for CL suitability? (8)
Environment (e.g. dusty) Occupation Low refractive error Monocular wear Poor hygiene Poor manual dexterity Sensitive eyes (fear of touching eyes) Poor motivation
Why might people with trichiasis benefit from CL wear?
CL will protect the ocular surface and make it more comfortable
Why might people with nystagmus benefit from CL wear?
May dampen nystagmus symptoms
What ocular indications are there for CL wear? (15)
High Rx Anisometropia Aphakia Trchiasis (bandage) Dry eye syndrome Exposure keratitis Nystagmus (kids) Recurrent erosions (bandage) Bullous keratopathy (bandage) Ocular disfigurement Unsuccessful refractive surgery Post-keratoplasty Keratoconus
Is self-esteem in children an indication for CL wear?
yes
What type of CLs would you consider for a patient with recurrent corneal erosions or bullous keratopathy?
Bandage contact lenses
What type of CLs would you consider for a patient with either keratoconus, post-keratoplasty or unsucessful refractive surgery? What does this achieve?
Hard contact lenses. Corrects for cornea shape, which is different/can be different in these situations
What should you consider when assessing CL suitability for a patient with recurrent corneal erosions or bullous keratopathy?
we don’t want to reduce oxygen too much because we don’t want to slow the healing response too much
Why may CLs be indicated for dry eye syndrome patients?
can keep the cornea moist by using the right CLs in cases of severe dry eye
What is a bandage contact lens?
is a contact lens designed to protect an injure or diseased cornea from the mechanical rubbing of the blinking eyelids, therefore allowing it to heal. The bandage lens often makes the eye feel more comfortable
Is a bandage lens soft or hard?
It’s usually a soft contact lens, but not always.
What is Bullous keratopathy?
is the presence of corneal epithelial bullae, resulting from corneal endothelial disease caused by edema of the cornea, resulting from failure of the corneal endothelium to maintain the normally dehydrated state of the cornea. (I.e. endothelial pump failure causes this)
List 11 ocular indications where extra care may be required when considering CLs
Cosmetically noticeable strabismus Conjunctivitis Dry eye Glaucoma History of keratitis (e.g. herpes simplex) Ocular allergies/hayfever/atopy Decreased corneal sensitivity Pingueculae Lid conditions (chalazion, hordeoleum, acute blepharitis) Pterygia Uveitis
What might be a problem when fitting CLs in a patient with strabismus? (2)
CL might not sit at optical centre
Changing the power in CLs (due to no vertex distance) from specs with high prescription may make STRAB more obvious
Why might glaucoma be a problem for CL wear in a patient? What might you advise patients in this scenario?
Eye drop tx for glaucoma may be less effective with CLs. Perhaps advise px to wait 15 minutes after eye drop before putting on CLs
What should you consider when giving CLs to a patient with blepharitis?
the gunk might get trapped between the CL and the eye
What systemic factors can influence CL wear? (9)
General Health Smoking Chronic sinusitis Allergies Skin problems Endocrine changes Thyroid disease Pregnancy Medication
(basically any condition that alters tear flow, production, anterior surface properties)
How can general health affect CL wear?
if health is poor then contact lens tolerance may be affected
How can smoking affect CL wear? (2)
Dry eye
Particulate matter
