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