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Contact Lens Complications E-Book

Contact Lens Complications E-Book

Nathan Efron

(2012)

Additional Information

Book Details

Abstract

Effectively manage even the most challenging contact lens complications with help from Contact Lens Complications, 3rd Edition! Award-winning author, clinician, and researcher Professor Nathan Efron presents a thoroughly up-to-date, clinician-friendly guide to identifying, understanding, and managing ocular response to contact lens wear.

  • Evaluate and manage patients efficiently with an organization that parallels your clinical decision making, arranging complications logically by tissue pathologies.
  • Turn to the lavish illustrations and full-color schematic diagrams for a quick visual understanding of the causes and remedies for contact lens complications.
  • Stay up to date with the latest advances and concepts in contact-lens-related ocular pathology, including findings from the Dry Eye Workshop (DEWS), the International Workshop on Meibomian Gland Dysfunction, a new approach to corneal inflammatory events and microbial keratitis, and new instrumentation and techniques for anterior eye examination.
  • Consult the most comprehensive and widely-used grading system available, as well as 350 new references that reflect an evidence-based approach, and dozens of superb new illustrations that help you instantly recognize clinical signs.

Table of Contents

Section Title Page Action Price
Front Cover cover
Contact Lens Complications i
Copyright Page iv
Table Of Contents v
Preface vii
Acknowledgements ix
Dedication ix
Contact lens complications quick-find index xi
I Examination and grading 1
1 Anterior eye examination 1
Burton lamp 1
Slit lamp biomicroscope 1
General construct 2
The slit lamp 2
The biomicroscope 3
Illumination and observation techniques 4
Diffuse illumination 4
Focal illumination – parallelepiped 5
II Eyelids 39
4 Blinking abnormalities 39
The normal spontaneous blink 39
Mechanism of blinking 39
Types and patterns of blinking 39
Purpose of blinking 40
Alterations to blinking caused by contact lenses 41
Blink rate 41
Blink type 41
Complications of abnormal blinking with contact lenses 41
Lens surface drying and deposition 41
Visual degradation 42
Prolonged lens settling 42
Epithelial desiccation 42
Post-lens tear stagnation 42
Hypoxia and hypercapnia 43
Soft lens staining 44
Rigid lens 3 & 9 o’clock staining 44
Lens design and fitting 44
Management of abnormal blinking with contact lenses 45
Differential diagnosis of blinking abnormalities 45
References 45
5 Eyelid ptosis 47
Signs 47
Severity 47
Time course of onset 48
Symptoms 48
Prevalence 48
Rigid lenses 48
Soft lenses 48
Pathology 49
Aetiology 49
Aponeurogenic causes of CLIP 49
Forced lid squeezing 49
Lateral eyelid stretching 49
Rigid lens displacement of tarsus 49
Blink-induced lens rubbing 49
Excessive force used in soft lens handling 49
Non-aponeurogenic causes of CLIP 49
Oedema 49
Blepharospasm 50
Papillary conjunctivitis 50
Patient management 50
Prophylaxis 50
Surgical correction 50
Non-surgical management 51
Prognosis 51
Differential diagnosis 51
Aponeurogenic ptosis 51
Non-aponeurogenic ptosis 52
Other contact lens-associated eyelid disorders 52
Increase in palpebral aperture size 52
Embedded lens 52
Ectropion 52
Entropion 53
Lagophthalmos 53
Rigid lens ‘bridging’ 53
Absence of eyelid 53
Lids as a lens positioning tool 53
References 54
6 Meibomian gland dysfunction 56
Prevalence 57
Signs and symptoms 57
Pathology 60
Aetiology 60
Patient management 61
Warm compresses 61
Heating devices 61
Lid scrubs 61
Mechanical expression 62
Antibiotics 62
Calcineurin inhibitors and cyclosporine 63
Sex hormones 63
Essential fatty acids 63
Artificial tears 63
Topical lipid supplements 63
Intraductal probing 63
Surfactant lens cleaning 63
Prognosis 64
Differential diagnosis 64
Other contact lens-associated meibomian gland disorders 64
References 65
7 Eyelash disorders 67
External hordeolum (stye) 67
Blepharitis 67
Staphylococcal anterior blepharitis 68
Seborrhoeic anterior blepharitis 68
Implications for contact lens wear 68
Parasite infestation of eyelashes 69
Mites 69
Demodex folliculorum 69
Demodex brevis 70
General characteristics 70
Lice 71
Treatment of mite infestation 72
Treatment of lice infestation 73
Management in contact lens wearers 73
Other contact lens-associated eyelash disorders 73
Insects trapped in eyelashes 73
Shedded eyelash entering the eye 74
Trichiasis 74
Distichiasis 75
References 75
III Tear film 76
8 Dry eye 76
The normal tear film 77
Structure 77
Function 77
Signs of tear film dysfunction in contact lens related dry eye 78
General observation 78
Tear volume 78
Tear film structure and quality 79
Tear film stability 81
Ocular surface staining 82
Lid-wiper epitheliopathy 82
Lens deposits 82
Post-lens tear film 83
Symptoms 83
Pathology and aetiology 83
Osmolarity 84
Acid–base balance (pH) 84
Composition 84
Temperature 85
Tear film turnover 86
Tear break-up 86
Feedback model 87
Treatment 87
Choice of contact lens 87
Hydrogel lenses 87
Silicone hydrogel lenses 87
Choice of contact lens care solutions 87
Re-wetting drops 88
Soft lens soaking 88
Nutritional supplements 88
Oral omega-6 essential fatty acids 88
Control of evaporation 89
Reduction of tear drainage 89
Tear stimulants 89
Management of associated disease 90
Bandage lenses 90
Reduced wearing time or cessation of lens wear 90
Cessation of smoking and avoidance of passive exposure to cigarette smoke 90
Prognosis 90
Differential diagnosis 90
References 91
9 Mucin balls 95
Signs 95
Time course 96
Prevalence 96
Associated observations 97
Symptoms 97
Aetiology 97
Pathology 98
Structure and composition of mucin balls 98
Pathogenesis of mucin ball formation 98
Consequential pathology 99
Management 100
Prognosis 100
Differential diagnosis 100
References 101
IV Conjunctiva 102
10 Conjunctival staining 102
Appropriate staining agents 102
Staining technique 103
Signs and symptoms 104
The normal eye 104
Contact lens wear 105
Prevalence 105
Types of staining 105
Stipple staining 105
Arcuate staining 106
Lid-parallel conjunctival folds (LIPCOF) 106
3 & 9 o’clock staining 107
Pathology 107
Interpreting fluorescein staining 107
Impression cytology 107
Confocal microscopy 107
Other approaches 108
Aetiology 108
Treatment 109
Prognosis 110
Differential diagnosis 110
References 110
11 Conjunctival redness 113
Definitions 113
Prevalence 113
Signs and symptoms 114
Pathology 115
Aetiology 115
Metabolic influences 116
Chemical influences 116
Toxic reaction 116
Allergic reaction 116
Neural control 116
Inflammation 117
’Contact lens acute red eye’ syndrome 117
Mechanical influences 117
Observation and grading 118
Treatment 118
Alteration to the lens 118
Alteration to care systems 119
Improving ocular hygiene 119
Pharmaceutical agents 119
Prognosis 119
Differential diagnosis 120
References 121
12 Papillary conjunctivitis 122
Prevalence 122
Normal tarsal conjunctiva 123
Signs and symptoms 123
Pathology 125
Aetiology 125
Mechanical trauma 125
Immediate hypersensitivity 126
Delayed hypersensitivity 126
Individual susceptibility 126
Meibomian gland dysfunction 127
Observation and grading 127
Treatment 128
Alteration to the lens 128
Alteration to care systems 128
Improving ocular hygiene 128
Pharmaceutical agents 129
Mast cell stabilizers 129
Corticosteroids 129
Non-steroidal anti-inflammatory agents 129
Antihistamines 129
Vasoconstrictors 130
Combination therapy 130
Prognosis 130
Differential diagnosis 130
References 131
V Limbus 133
13 Limbal redness 133
Signs and symptoms 133
Anatomical considerations 133
Clinical observations 134
Pathology 135
Aetiology 136
Hypoxia 136
Infection 136
Inflammation 136
Trauma 137
Solution toxicity or hypersensitivity 137
Lens deposits 137
Management 137
Prognosis 137
Differential diagnosis 138
References 139
14 Vascularized limbal keratitis 140
Signs and symptoms 140
Grade 1 140
Grade 2 140
Grade 3 141
Grade 4 141
Pathology 141
Aetiology 141
Treatment 142
Grade 1 142
Grade 2 142
Grade 3 142
Grade 4 142
Prognosis 142
Differential diagnosis 144
References 145
15 Superior limbic keratoconjunctivitis 146
Prevalence 146
Signs and symptoms 147
Pathology 148
Aetiology 149
Thimerosal hypersensitivity 149
Thimerosal toxicity 150
Mechanical effects 150
Lens deposits 150
Hypoxia beneath upper lid 151
Treatment 151
Suspension of lens wear 151
Elimination of thimerosal 151
Alteration to the lens 151
Pharmaceutical agents 151
Bandage lenses and pressure patching 152
Surgery 152
Prognosis 152
Differential diagnosis 152
References 153
VI Corneal Epithelium 155
16 Corneal staining 155
Prevalence 155
Non-lens wearers 155
Lens wearers 155
Signs and symptoms 156
Vital stains 156
Fluorescein 156
Sequential fluorescein staining 156
Rose Bengal 156
Lissamine green 156
Slit lamp biomicroscope appearance 156
Punctate staining 157
Diffuse staining 157
Coalescent staining 157
3 & 9 o’clock staining 157
Dimple-veil ‘staining’ 157
Inferior epithelial arcuate lesion (’smile stain’) 158
Superior epithelial arcuate lesion (SEAL) 158
Epithelial plug 159
Solution-induced corneal staining (SICS) 159
Preservative-associated transient hyperfluorescence (PATH) 160
Other forms of staining 160
Vision 160
Comfort 160
Pathology 160
Aetiology 161
Mechanical 162
Exposure 162
Metabolic 162
Toxic 162
Allergic 163
Infectious 163
Observation and grading 163
Management and treatment 164
Mechanical 164
Exposure 164
Metabolic 164
Toxic 164
Allergic 164
Infectious 164
Prognosis 164
Differential diagnosis 165
References 165
17 Epithelial microcysts 167
Prevalence 167
Signs and symptoms 167
Slit lamp biomicroscope appearance 167
Optical effects 168
Vision 169
Comfort 169
Time course of onset 169
Pathology 169
Aetiology 170
Management and treatment 170
Prognosis 171
Ceasing hydrogel extended lens wear 171
Microcyst ‘rebound’ 171
Differential diagnosis 172
References 172
18 Epithelial oedema 174
Signs and symptoms 174
Vacuoles 174
Bullae 175
Vision 175
Pathology 175
Inferences from clinical observations 175
Electron microscopic studies 176
Aetiology 176
Management 176
Prognosis 177
Differential diagnosis 177
References 177
19 Epithelial wrinkling 179
Prevalence 179
Signs 179
Symptoms 181
Pathology 181
Aetiology 182
Treatment 182
Prognosis 183
Differential diagnosis 183
References 184
VII Corneal Stroma 185
20 Stromal oedema 185
Definition 185
Central corneal clouding (CCC) 185
Prevalence 186
Signs and symptoms 186
Striae 186
Folds 186
Haze 187
Pathology 187
Striae 188
Folds 188
Haze 188
Aetiology 189
Observation and grading 189
Grade 0 189
Grade 1 189
Grade 2 189
Grade 3 190
Grade 4 190
Management and treatment 190
Alleviating rigid lens oedema 190
Material Dk 190
Lens thickness 190
Base curve 190
Edge lift 190
VIII Corneal Endothelium 272
27 Endothelial bedewing 272
Incidence 272
Signs and symptoms 272
Pathology 273
Aetiology 274
Patient management 275
Prognosis 275
Differential diagnosis 275
References 276
28 Endothelial blebs 278
Prevalence 278
Signs and symptoms 278
Pathology 279
Electron microscopy 279
Slit lamp biomicroscopy 280
Confocal microscopy 280
Aetiology 281
Observation and grading 282
Management 282
Prognosis 283
Differential diagnosis 283
References 283
29 Endothelial cell redistribution 285
Normal endothelial cell density 285
Signs and symptoms 286
Pathology 287
Aetiology 287
Observation and grading 288
Management 288
Prognosis 289
Differential diagnosis 289
References 289
30 Endothelial polymegethism 291
Normal corneal morphology 291
Signs and symptoms 291
Corneal exhaustion syndrome 292
Prevalence 292
Pathology 293
Aetiology 295
Observation and grading 295
Management 296
Prognosis 296
Differential diagnosis 297
References 297
Appendices 299
Appendix A Grading scales for contact lens complications 301
Appendix B Guillon tear film classification system 307
Index 313
A 313
B 313
C 313
D 314
E 314
F 315
G 315
H 315
I 316
K 316
L 316
M 316
N 317
O 317
P 317
R 317
S 317
T 318
U 318
V 318
X 318
Y 318