GP Lens Management Guide – 10

General Problem-Solving (continued)

Vascularized Limbal Keratitis

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

Lens Adherence

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

Poor Initial Wettability

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

Poor Acquired Surface Wettability

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

Crazing

Symptoms

  • Poor or fluctuating vision

Causes

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

Diagnosis

  • Surface cracks

Management

  • Replace lenses
  • Switch lens materials

Hypersensitivity

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

Go Back to Table of Contents