3-9 o’clock staining aetiology
- poor edge designs
- thick edge design
- edge clearance too large or too small
- TD too large or too small
- insuffient blinking
- can be asymptomatic
- irritation and dryness
- reduced wear time
3-9 signs
- usually bilateral
- follows shape o the lens
- bulbar redness
- nasal and temporal punctate staining
- can coalesce over time
- can lead to neovascularisation/ulceration/scarring
3-9 management
- Refit with thinner edge design
- refit with SiHy
- refit with GP lens if over 2.00DC
- ocular lubricants
- blinking exercises
- may lead to reduced wear time
What is vascularised limbal keratitis
- chronic 3-9 staining
- EW at risk
- mechanical irritation
- rare
- large. Diameter lenses
Vascularised limbal keratitis signs and symptoms
Symptoms
- possibly asymptomatic
- increased redness
- increased discomfort
- possible pain
- photophobia and lacrimation
Signs
- limbal mass with blood vessels
- appears opaque and elevated
- associated with conj staining
Vascularised limbal keratitis management
- stop CL wear
- consider refitting flatter lens
- ocular lubricants
- can be reversed
- monitor with regular aftercare appointments
What are dellen, and its risk factors
- dissociation at peripheral cornea
- due to dehydration of cornea
- layers compact together
Risks
- thick lens edge
- increased tear evaporation
- pterygium/pinguecula
- post surgery
Dellen signs and symptoms
Symptoms
- possibly asymptomatic
- possible 3-9 staining
- can present with irritation and dryness
Signs
- saucer like depression
- can pool with flouroscein
- localised thinning of cornea
- epithelium usually intact
Dellen management
- manage 3-9 staining
- rewetting drops
- blinking exercises
- cease CL wear
- reduce wear time
- refit with soft lens
What is a dimple veil, and its symptoms and management
- It is indentations in the epithelium caused by air bubbles trapped under lens
- pools with flouroscein
- caused by excessive corneal clearance
Symptoms
- usually none
- reduced vision if central and numerous
Management
- reduce CL wear
- prevent by altering fit, reduce edge lift and central clearance
What is a foreign body track
Material trapped by CL
- eyelashes, deposits etc
Symptoms
- asymptomatic to sharp pain
Management
- irrigation
- remove lens
- possible antibiotic
Other corneal problems with RGPs
Corneal oedema
Vascularisation
Acanthomeoba keratitis
RGP adherence, symptoms and management
- common in EW
- caused by thinning of tear film and eyelid pressure
- can be asymptomatic or FB sensation and blurred vision
Management
- back to DW
- ocular lubricants
- lower total diameter
- do not remove lens until mobile
What is lens warpage, and its symptoms and management
- heavy handling
- flat on lens case
- allowed to dry out
- thin lens
- pressed into lens case
Symptoms
- reduced vision
- discomfort
- reduced wear time
Management
- Px education
- replace lens
- increase lens thickness
How can RGPs cause a ptosis, and what is the management
Mechanical interaction with lids causing inflammation and swelling, gravity pulls lids down
Management
- cease CL wear
- regular aftercare
- refit with SCLs
- make sure to rule out other causes
- reduced CL thickness
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Modality Of Wear13
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SCL Fitting13
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CLs And Oxygen10
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CL Manufacturing22
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SCL Complications29
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SCL Care11
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CL Aftercare7
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RGP Fitting18
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RGP I&R And Recording8
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CL Compliance10
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RGP CL Care4
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SCL For Astigmatism10
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RGP For Astigmatism9
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RGP Complications15
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Dry Eye In CLs8
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CL Fitting For Presbyopia10
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Corneoscleral GP Lenses5
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CL Verification10
