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23 Cards in this Set
- Front
- Back
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CLARE
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Contact Lens Acute Red Eye (CLARE).
Signs: Bulbar injection, Discomfort/pain, Lacrimation, Photophobia. Cause: Inflammation to microbial toxins (mainly GRAM NEGATIVE) which adhere to CL surface. They release lipopolysaccharides. NON-INFECTIOUS Occurs upon awakening during extended soft contact lens wear Common Gram - : Pseudomonas aeruginosa. Also caused by: Hypoxia/hypercapnia, tight lens syndrome. |
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CLARE findings
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Bulbar and limbal injection.
Subepithelial infiltrates and NO STAINING of epithelium. Infiltrates in periphery or mid periphery. Tight Lens with trapped debris (tight lens syndrome). Possible AC reaction. Endothelial bedewing and guttata. |
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CLARE treatment
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Discontinue Lens wear, especially EW.
Fluoroquinolone QID (Zymar, Vigamox) antibiotic. Replace, refit lens. Increase Dk/t. Silicone Hydrogels have less Gram(-) bacteria, so less CLARE if switched to SH. |
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Contact Lens Peripheral Ulcer (CLPU)
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Anterior stromal infiltrate with overlying full thickness epithelial defect.
Staph. aureus gives off exotoxin and is the MOST COMMON CAUSE of CLPU. Due to Gram(+) (staphylococcus) toxins, neo, edema, solution preservatives, surface deposits, tight lens. |
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Contact Lens Peripheral Ulcer (CLPU) Signs
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Localized bulbar and or limbal injection.
Small <2mm, localized haze or edema. No AC or Photophobia. WILL SCAR with bulls-eye appearance. Will not culture positively (Sterile ulcer) and is thus ANTIGEN in origin. |
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Contact Lens Peripheral Ulcer treatment
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Discontinue lens wear. It will improve almost immediately. (A Microbial Keratitis infection will worsen.)
Fluoroquinolone QID (Vigamox, Zymar) prophylactic treatment to make sure it isn't MK. Add steroid to hasten resolution. Discontinue EW and refit DW. |
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CLPU and Silicone Hydrogels
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Can still occur with SH because it is NOT related to HYPOXIA. Equal chance with any sCL.
It is a immune reaction of ANTIGEN origin. |
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Phlyctenulosis
(flick-ten-ulosis) |
Delayed sensitivity to staph toxins.
Also occurs in chlamydia and TB. Elevated white lesions on cornea, limbus or conjunctiva. Have Eosinophils and are vascularized with NO CLEAR ZONE between lesion and limbus. Tx: Steroids and Antibiotic (Tobradex). |
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Contact Lens-induced Papillary Conjunctivitis (CLPC)
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Papillary hypertrophy and tarsal inflammation from CL wear (GPC).
Papillae: elevated and filled with mast cells containing histamine. Surface protein deposition, excessive lens movment, conjunctival edema and ptosis. Higher level of CLPC in SH due to higher modulus/stiffness. |
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Infiltrative Keratitis
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Acute inflammation of corneal tissue with the presence of intraepithelial or subepitheliial infiltrates.
NO microbial infection/infiltration into the cornea. (Ie antibiotics don't work.) Found in Anterior Stroma with NO epithelial defects. Can be due to tight lens, solution sensitivities, staphy sensitivity, or lid hygiene. |
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Microbial Keratitis (MK)
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Loss of epithelial and stromal tissue due to invading pathogenic bacteria. Hypoxia must weaken the epithelial cells to allow entrance of bacteria.
May occur after corneal trauma or decompensation in EW CLs. May occur as non-infectious infiltrat with overlying epithelial defect. |
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Microbial Keratitis Risk Factors
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Most important: HYPOXIA!! Weakens epithelium.
EW, Bacterial colonizaiton (gram neg.), poor hygieine, trauma, tight lens, smokers. |
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Pseudomonas aeruginosa
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Gram Negative (-).
Releases an ENDOTOXIN after colonizing a CL. Causes CLARE syndrome. Needs a predisposing corneal epithelial trauma to cause MK or CLARE. Toxin will continue to eat at cornea after removal of bacteria. Can get hypopyon. |
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Pseudomonas Microbial Keratitis (MK) Signs
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Sever PAIN, REDNESS, PHOTOPHOBIA.
Discharge, blurry vision (can loose vision in 24-48 hours), large lesions >2mm. LID SWELLING: highly indicative!! |
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Pseudomonas Microbial Keratitis Managment
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Discontue lens wear immediately, culture if possible.
Tx: if not on visual axis. Ref: if on visual axis, sent to corneal specialist. Fluoroquinolone monotherapy (Vigamox, ciloxan). Fortified Antibiotics. Cycloplegia, pain management OTC. |
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Fungal Keratitis
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Rare unless HIV or gross noncomplicance.
Cause: Fusarium (B&L ReNu with moisture lock) |
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Acanthamoeba Keratitis
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RARE, 2 in 1 million.
Often mistaken for herpes, but tx exacerbates infection. NO HERPETIC TERMINAL END BULBS. Found in all environment but common shower and swimming. |
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Infiltrative Keratitis
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Acute inflammation of corneal tissue with intraepithelial or subepithelial infiltrates.
No microbial infection. Source: Bacterial TOXINS like CLARE. FB trapped under lens. Trauma. Soln. Preservatives Surface deposits. |
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Infiltrative Keratitis Symptoms
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Starts in Day.
Mild pain, redness, tearing. Infiltrates are peripheral, small, and rarely scar. |
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Infiltrative Keratitis management
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Discontinue lens wear until resolved.
ATs, NSAIDS, Tobradex. Decrease wear time, increase lens care, change lens type. |
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Serious Sight Threatening Reaction
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MK
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Significant adverse reaction
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CLARE, CLPU, IK
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Bacterial Colonization is the INITIATING Factor in the following five cases:
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1. Microbial Keratitis (MK)
2. CLARE 3. CLPU 4. Infiltrative Keratitis (IK) 5. Acanthamoeba Infiltrative Keratitis (AIK) |
