Contact Lens Quiz - CL Complications

What is Inferior arc staining (Smile Stain) ?

- Asymptomatic - More common in SCL wearers - Cause is usually multifactorial - No specific treatment.. refit if symptomatic

Complications: Ulceration (Cornea)

- CL overwear or non-compliance can compromise the corneal epithelium - Facilitate development of infectious or non-infectious keratitis

What is 3-9 o'clock staining?

- Common GP finding (SCL cover the entire limbus) - Mild punctate staining at limbus from poor blinking, poor centration, or poor edge design (thickness or lift) - Mild can be monitored... Severe needs lens change

What is Vascularized Limbal Keratitis (VLK)? (trio of findings? Concerns? Symptoms? Treatment?)

- Continuation of 3-9 o'clock staining - Rare complication of GP lenses from: Too little edge lift, decentration, steep and large diameter corneal lenses.. Poor wetting, surface defect of lenses, chronic mechanical desiccation at limbus Trio of Findings: 1. Severe 3 and 9 stain 2. Raised, inflamed, semi-opaque epithelial lesion 3. Localized vascularization of cornea Concern: - Damage to gimbal stem cells, compromise the cornea's ability to heal - Untreated can lead to progression of neovascularization Symptoms: - Discomfort, photophobia, lacrimation, lens awareness, decreased wearing time, visualization of the lesion Tx: - Discontinue lens wear, lubrication, corticosteroid, improve lens cleaning - Refitting lens after healing: decrease OAD, flatten BC, increase edge lift, large diameter/scleral lens

What are some contact lens options that you could recommend to improve the convenience for your patient to wear CL's?

- Daily disposables (no cleaning, specific activities, special occasions) - Continuous wear (minimal handling/cleaning.. SCL to wear for as long as 30 days) - Multipurpose solutions - Ortho-K (no daytime wear) - Multifocals (Reduce need for reading glasses)

What would you see in a staining pattern if patient has a hypersensitivity or toxicity to their lens solution?

- Diffuse staining pattern/infiltrates - Usually mild but can be mild

What is the #1 issue that is inhibiting growth in the CL industry?

- Dry Eye

Complications: Contact Lens Induced Papillary Conjunctivitis (CLPC) aka Giant Papillary Conjunctivitis (GPC) (Palpebral Conjunctiva)

- Inflammatory reaction due to denatured proteins on the lens surface Signs: - Large papillae 1-2 mm in size - Hyperemia - Excess lens movement - Can persist for long time even after treatment Symptoms: - Increased lens awareness - Itching even upon removal of CL - Stringy mucous discharge, especially in am - Transient blur - Foreign body sensation Treatment: - It's an allergy - Discontinue lens wear until resolved - Topical antihistamine/mast cell stabilizer (patanol, elestat) - Topical steroid for severe (Lotemax qid x 2 weeks then taped) - If asymptomatic but see signs, give OTC allergy drop (alway or zaditor)

Complications: Papillae (Palpebral Conjunctiva)

- Inflammatory reaction usually due to protein interaction - Most CL wearers will have mild papillae due to chronic irritation to superior palpebral conjunctiva *Sometimes hard to know what exactly is the cause; irritation, environmental allergies, etc.

What are the common culprits to dirty lenses?

- Lipid, protein deposit or poor gettability (anything from the environment/tear film)

Infiltrative Keratitis (IK)

- Non-infectious, inflammatory rxn in SCL wearers; all you see are infiltrates, no infection - Associated with certain SiHy lenses and MPS (poor compliance) Signs: - Multiple small, round gray-white mid-peripheral or stromal infiltrates - No epithelial defect - Diffuse injection Tx: - dc CL wear - Palliative with PF AT - May treat with steroid or combo AB/steroid - Switch solution or refit CL - Can be self-limiting hour stop 7-14days

What are 2 ways in which contact lenses can cause a refractive error change over time?

- RGP: hyperopic shift due to mechanical effect of lens on cornea; Ortho-k does this on purpose but here it's accidental - Low Dk SCL: myopic creep... chronic edema causes change to corneal thickness which increases the power of the cornea * 0.125D per year... both are mild changes

Complications: Bulbar conj hyperemia (redness) *CLARE

- Red eye means inflammation - Caused by dry eye, active infection, inflammation, hypoxia, mechanical, allergic Contact Lens Acute Red Eye - Sudden onset of pain, redness, tearing and photophobia - Diffuse, angry red eyes - Perilimbal injection - Tx: Discontinue lens wear until resolved; if severe use steroid/AB combo; Refit to looser fitting CL or switch to peroxide system

Epithelial Depressions: Dimple Veiling

- Steep RGP: air bubbles under the surface leave depression that pool NaFl (not true staining) - Go FLATTER! *Not a huge complication but can affect a pt's vision (bring sag down)

Contact Lens Peripheral Ulcer (CLPU)

- Sterile infiltrate event - Usually with EW Cl's Signs: - Peripheral, unilateral - Small, discrete, well-rounded infiltrate - Full epithelial loss ->stains with NaFl Symptoms: - Mild FBS to pain - Occ tearing - Mild photophobia Tx: -dc CL wear - Usually heals rapidly but it requires close monitored! Could be early MK

Microbial Keratitis (MK)

- True infectious corneal ulcer characterized by excavation of the corneal epithelium, bowman's and storm with infiltration and necrosis of tissue Symptoms: - Rapid onset; severe pain - Severe photophobia Signs: - Lid edema - Mucopurulent discharge - Sever conj injection - Decreased acuity - anterior chamber rxn common - Epithelial defect/ulceration Cause: - Mostly gram (-)... like pseudomonas

Epithelial Depression: Mucin Balls

- Unique to SiHy's - Hydrophobic properties of lens surface interacting with mucin layer - Press into epithelium and create little craters in the surface (benign) - Switch to lower modulus seems to help *DON'T see anymore b/c of modern day lenses

Complications: Superior Epithelial Arcuate Lesion (SEALs) (Limbus/Corneal edge)

- aka Epithelial Splits => superior arc staining under lid - Often asymptomatic - Produced by mechanical chafing; more common in hydrogel SCL - Resolves quickly with no lens wear - Refit with lower modulus lens

Complications: Bulbar Conjunctiva Staining (Near Limbal Staining vs Diffuse staining vs Furrow staining)

Near Limbal Staining: - Tight SCL: mechanical pressure - Dry Lens: desiccation - Stiff lens: mechanical pressure Diffuse Staining: - Solution toxicity, Viral, or DES Furrow Staining: - Normal finding (commonly found in older pt's)

Complications: Limbus CL SLK (Superior Limbic Keratoconjunctivitis) (Limbus/Corneal Edge)

Symptoms: - Increased lens awareness/intolerance - FB sensation - Burning/itching - Photophobia - Lacrimation Signs: - Monocular - Superior localized injection, boggy bulbar conj - Superior: limbal hyperemia, conj and corneal punctate staining, filtrates, haze in epithelium - LIFT UPPER LID - (+) stain with NaFl, RB, LG Cause: - Thimerosal rxn (rare today) - CL over wear - Hypoxia under lid (low Dk lens) - Mechanical (stiff lens material or damaged) more common Treatment: - DC wear - Preservative artificial tears - Stop thimerosol if used - Change care systems - Refit with higher Dk/t but beware of high modulus materials (might be stiffer cause more problems) - Topical steroid if severe - Cool compress (palliative tx)