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..