contact lens complication
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CONTACT LENS CONTACT LENS COMPLICATIONCOMPLICATIONBy:NOOR MUNIRAH BINTI AWANG ABU BAKARP82498
INTRODUCTION INTRODUCTION The principle causes: COMPLIANCE & COMPATIBILITY◦Inadequate lens-cornea relationship◦Insufficient O2 transmissibility ◦Poorly maintained CL & CL case◦Incompatibility to material & solution◦Not comply to the dos and don’ts
STATISTICSTATISTICCBS news, Aug 20, 2015 CDC:
Contact Lens wearers are putting their eyes at risk.
Report from US Centers for Disease Control and Prevention◦ Risk of an eye infectionPercentage Activity with lens on87% Sleep85% Showered61% Swimming 55% Top off lens solution in the lens
case99% Neglect CL hygiene at least
once30% Rinse with tap waterResearch: 1000 contact lens wearer, age >18 years old
CL WEAR COMPLICATIONSCL WEAR COMPLICATIONSEyelids Tear film Conjunctiva
Corneal epithelium Limbus
Corneal stroma Corneal endothelium
TEAR FILMTEAR FILMDRY EYE
•Why?•Tear volume deficiency•Excessive tear evaporation
•Complaints: •burning, dryness, irritation, blurry vision
•Associated with:•MGD, reduced tear prism
•Diagnosis:• TBUT, Schirmer, Phenol red test, lissamine green
•Management: •Rewetting drops, lid and lens margin
EYELIDS EYELIDS Meibomian gland
dysfunction(MGD)
•What?•An inflammation /blockage affect meibomian gland•37%-47% suffer
•Signs: •Oily droplet along lid margin•Greasy lens
•Symptoms: •Smeary vision, dryness, itchiness, irritation,
•Management: •Lid hygiene, warm compression, artificial tears, mechanical expression
CONJUNCTIVACONJUNCTIVACL PAPILLARY CONJUNCTIVITIS
(CLPC)•Signs:
•Papillary changes-cobblestone formation•Conjunctival redness
•Complaints: •Itching, blur vision, discomfort
•Diff. Diagnosis:• Follicles
•Management: •Off lens wear, Alter lens type, design or wearing modailty, alter care system and ocular hygiene
CL PAPILLARY CONJUNCTIVITIS (CLPC)◦Causes : varies individually
Allergy to solution or lens material Mechanical Trauma
Cl coating cause trauma to the conjunctiva-release inflammatory mediator
Individual suceptibility
LIMBUSLIMBUSNEOVASCULARIZATION
•What?•New growth of blood vessel•18% in extended CL wear ; 11% in daily wear soft cl
•Why?•Hypoxia
•Complaints: •VA lost if extreme
•Management: •Discontinue CL wear, change CL with high Dk/t, topical corticosteroid
CORNEAL EPITHELIUMCORNEAL EPITHELIUMCORNEAL STAINING
•What?•Apperance of bright areas of fluorescein in epithelium
•Type:•3& 9 O’clock-RGP• Dimple veiling-RGP•Inferior Epi. Arcuate lesion (SMILE)•Superior Epi Arcuate Lesion(SEAL)
•Symptoms: •Asymptomatic (vision & comfort)•Photophobia (severe cases)
•Signs: •VA unaffected
CORNEAL EPITHELIUM CORNEAL EPITHELIUM cont. cont.
CORNEAL STAINING•Diagnosis:
• fluorescein & cobalt blue filter to check corneal integrity/tissue disruption
•Management: •Rewetting drops,•lid hygiene •lens hygiene
CORNEAL STROMACORNEAL STROMAACANTHAMOEBA KERATITIS
•Why?•Replication of amoebae•Extended CL wear
•Complaints: •Pain, redness, photophobia
•Associated with:•hypoxia
•Diagnosis:• paracentral lesion or central lesion•AC with cell & flare
•Management: •Stop cl wear, topical medication
CORNEAL ENDOTHELIUMCORNEAL ENDOTHELIUMENDOTHELIAL POLYMEGATHISM
•What?•Varies in cell size•With polymorphism(shape)
•Smptoms: •Corneal exhaustion syndrome (discomfort & reduce wearing time)
•Causes:•Hypoxia•Hypercapnia
•Management: •Reduce wearing time•Fit higher dk/t lens
CONCLUSIONCONCLUSIONPatients may have one or more
complications. Some of complications related
each other, thus complete management should be considered.
References:References:1. Efron, N. Contact Lens Complication.
2nd. Ed. 2004:Butterworth Heinemann.
2. Cohen, P. CDC: Contact Lens wearers are putting their eyes at risk. Aug 20, 2015. CBS News..
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