CONTACT LENS INDUCEDPATHOLOGY
ADVERSE RESPONSES OF EYE DUE TO CL WEAR
Cornea
1. Neovascularization
2. Oedema
3. Microcysts
4. Staining
5. Blebs
6. Polymegathism
7. CLPC
8. Infiltrates
9. Corneal warpage
10.Bedewing
11.Vacuoles
12.Bullae
13.SEAL (Superior epithelial arcuate lesion)
14.3 and 9 o clock staining (hard lenses)
15.Thickness changes
16.Decreased oxygen uptake
17.Keratitis
18.pH changes
19.PRPH (percentage recovery per hour)
20.Toxic reactions
Conjunctiva
SLK (superior limbic keratoconjunctivitis
ARE (acute red eye)
Lids
Ptosis (hard lens)
Blinking changes
DEPOSITS
Classification:
Tear related
Results from tear components:
- Lysozyme
- Lipids
- Albumin
- Mucin
- Ig A,G,E
- Lactoferrin
- Fibronectin
- CA
Organic/inorganic
Non-tear related
Environmental origin
Fbs
Build of rust on lens from oxidation of
iron particles on lens
1. Protein
Morphology
1.
2.
3.
4.
5.
6.
7.
Semi-opaque/translucent film
Thin, whitish and superficial
If extreme, will have frosted glass appearance
May cover surface partially/fully
Consists of denatured protein
Produces hydrophobic surface
Can crack and peel > discomfort
Short BUT
Ionic surfaces
Inadequate cleaning
Heat disinfection
Altered blinking
Deficient tears
Chronic allergies and GPC
Prevention > use protein removers
Replace lenses
Heroic cleaning
1.
2.
3.
4.
5.
Greasy, smooth and shiny adherent film
Finger print on lens look
Best seen between blinks
Affects vision > blinking = change in vision
Minute droplets loosely bound to lens surface
Hydrophobic surface
Thick oily coating primarily from meibomian glands
Tear film quality
Slow blink pattern
Poor lens care
Careless use of cosmetics and lotions
Easy removed using alcohol-based surfactant cleaner
3. Jelly bumps
Morphology
Clinical
Susceptibility
1.
2.
3.
4.
5.
6.
Consequence
1.
2.
s
3.
4.
Tx
Clump of raised translucent mulberry like deposits
Typically in inferior exposed portion of lens
Predominantly lipid
May include Ca, protein or mucin
Adverse effects on vision and comfort > px complaint
Quality of tear film
Poor blinking
Lens surface contamination
Water content of lens
Aphake (greater incidence)
Absence of surface cleaning
Discomfort
Ewxcessive movement (lid attachment of bumps)
Fluctuating vision
CLPC
New lenses
Clinical
Factors
favouring
protein build
up
Tx
2. Lipid
Morphology
Sx
Clinical
Predisposing
factors
Tx
4. Inorganic deposits
Clinical
Insoluble accumulations of tear components on surface and in lens
matrix
Deposits may
Inorganic film/salts
be
Ca carbonate
Ca phosphate
Morphology
White crystalline specks
Large/small
Rough surface
Penetrate lens surface if severe
Factors influencing susceptibility of a contact lens to deposits
1. Quality of tear film
2. Poor blinking
3. Lens surface contamination
4. Water content of the lens
5. Aphakes have greater incidence
6. Absence of surface cleaning
5 factors favouring build-up of protein on a contact lens
- short TBUT
- ionic surfaces
- inadequate cleaning
- heat disinfection
- altered blinking
- deficient tears
- chronic allergies/ GPC
