General Problem-Solving (continued)

Symptoms

• Lens awareness
• Localized ocular pain
• Decrease wearing time
• Red eye with elevated corneal mass upon self inspection in mirror

Causes

• Dryness
• Extended wear schedule
• S/A material
• Steep fitting with peripheral seal off
• Large diameter with very low edge lift

Diagnosis

• VLK progresses to four stages:
  1. Hyperplasia
  2. Inflammation
  3. Vascularization
  4. Erosion
• Observe elevated, opaque, vascularized area in the 3 or 9 o'clock region

Management

• Discontinue 5-7 days minimum
• Topical Ab-Steroid combo (qid x 1 wk, then taper)
• Consider F-S/A daily wear with flat peripheral bevel
• Smaller diameter to decrease mechanical irritation to limbus & cornea

Symptoms

• Lens awareness

Causes

• Dryness
• Lens decentration
• Deposits on back surface
• Peripheral sealoff
• Extended wear patients with low edge lift designs

Diagnosis

• No lens movement with blink

Management

• Improve lens centration
• Clean posterior lens surface
• Flatten peripheral curve
• Reduce to daily wear schedule
• Rewetting drops upon awakening and at night
• For EW, gentle lens manipulation of eyelid after application of lubricating drops

Symptoms

• Poor initial/ fluctuating vision

Causes

• Manufacturing-related problems (too much heat, inadequate finishing, residual pitch polish)

Diagnosis

• Haze
• Breakup of tear film on lens surface

Management

• Pre-soak lens overnight prior to dispensing
• Use a solvent followed by reconditioning with wetting solution
• Laboratory cleaner

Symptoms

• Gradual reduction in vision

Causes

• Patient compliance with cleaning regimen
• Lanolin-containing soap/lotion
• Poor wettable lens material
• Inadequate tear quality/volume

Diagnosis

• Muco-protein haze/film on lens front surface

Management

• Re-education in lens care and cleaning
• Avoid lanolin creams and/or soap prior to handling lens
• Use weekly enzymatic cleaning
• Change to F-S/A material

Symptoms

• Poor or fluctuating vision

Causes

• Material-related problems
• Patient use of alcohol-based cleaners

Diagnosis

• Surface cracks

Management

• Replace lenses
• Switch lens materials

Symptoms

• Burning
• Redness
• Itching
• Apprehensive patient

Causes

• Sensitivity to a preservative or accumulation of a preservative on a deposited lens surface
• Sensitive patient

Management

• Proper cleaning
• Change to a different preserved care regimen
• Topical anesthetic drop for the sensitive patient