More Common CL Complications

When there's staining in an area around the periphery of the lens it's likely to be one of two things. It could be lens binding which is more common in extended wear lenses, lenses that are too tight or px working in a dry atmosphere. It could also result from damage to the lens from fingernails/getting trapped in the case.

If there are particles visible underneath the lens it's often tear film debris. This is common in the sort of patient that just plonks their lenses in straight away in the morning. The debris will be visible under the slit lamp and will appear to be squashed down by the lens. If the debris is sleep debris then the patient isn't likely to notice it, but makeup has a more granular structure that will cause the lens to become uncomfortable. Mucin balls can be found under extended wear lenses - this is tear debris rolled into a ball by the movement of the lens.

CLPC

Symptoms include itchiness which worsens on removal of the lens. Also reduced wearing time. CLPC is a type IV delayed hypersensitivity reaction. There is a type I element too - the histamine response causing the itchiness.

CL wear should be discontinued for a good length of time - a guideline used = the efron grade of the CLPC x 2 = the number of months to discontinue wear.. EG grade 2 = discontinue for 4 months, assessing again 2 months in. Lens type should also be changed - dailies so that there are no further problems with denatured proteins. Also the lenses are thinner which minimises the mechanical action on the lids. You should expect improvement of at least 1 grade after a couple of months.

Mast cell stabilisers and anti=histamines can be used in the meantime to reduce symptoms as well as cold compresses. Some optoms actually just fit dailies straight away but if the CLPC is grade 2 or more that ain't going to work.

Flat Fitting RGP

Central abrasion that could ulcerate. Refit with steeper lens. The patient could wear the flat lens while the other lens is on order but

• minimise wearing time/wear specs when poss
• come straight back to practice if red eye/painful/blurry vision

Chronic Hypoxia corn neovasc

• Due to overwear, tight fit, lower H20 content lens
• Response = increase O2 transmission w/ultrathin lens/higher H20 content lens (NB consider whether PX will be able to wear higher water content lens in office with AC)

Steep Fitting RGP - Air Bubble?

• Could result in blinking w/froth + areas of dryness
• Fit flatter

Microcysts/Vacuoles

• Reversed light path = microcyst, unreversed = vacuole.
• Grade by counting numbers

Foreign Body

• Stromal diffusion of flu indicates deep!
• Give chloramphenicol every 2hrs for 12 hrs then 4x/day
• NB you have to take lenses out to put drops in, will px comply?
• See px in 24hrs, improvement? If not up dosage again or refer to hospital
• Check that foreign body isn't still around - slit lamp, under lids
• Need to work out cause, gardening accident? Could be something that could be avoided in the future