Contact lens problems - Revision history

Frankj1978: /* Management */ keratitis often implies ulcerative or infectious and for clarity should not be grouped with corneal abrasion

2022-03-17T19:16:37Z

Management: keratitis often implies ulcerative or infectious and for clarity should not be grouped with corneal abrasion

← Older revision		Revision as of 19:16, 17 March 2022
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	==Management==		==Management==
	*Corneal Ulceration- Infiltrate + epithelial defect + Anterior chamber reaction + Pain		*Corneal Ulceration (ulcerative keratitis)- Infiltrate + epithelial defect + Anterior chamber reaction + Pain
	**< 24 hour ophtho followup		**< 24 hour ophtho followup
	**Intensive topical Antibiotics- differing opinions but a safe option is 1-2 drops into the affected eye every 15 minutes for the first two hours and then hourly until seen by ophthalmology.		**Intensive topical Antibiotics- differing opinions but a safe option is 1-2 drops into the affected eye every 15 minutes for the first two hours and then hourly until seen by ophthalmology.
	**NEVER patch a contact lens wearer for comfort as this can accelerate infection		**NEVER patch a contact lens wearer for comfort as this can accelerate infection
	***The provider must stress the importance of strict adherence to the dosing protocol		***The provider must stress the importance of strict adherence to the dosing protocol
	*Corneal Abrasion ~~or keratitis~~		*Corneal Abrasion
	**urgent ophtho followup		**urgent ophtho followup
	**treat aggressively as above if ulcer cannot be excluded.		**treat aggressively as above if ulcer cannot be excluded.

2020-11-08T14:42:29Z

Disposition

← Older revision		Revision as of 14:42, 8 November 2020
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	==Disposition==		==Disposition==
			*Always instruct patients to remove contact lenses until cleared by an ophthalmologist.
	*if the above conditions are uncomplicated( no corneal perforation, vision loss, endophthalmitis, or other permanent visual threat) these patients may be discharged with next day ophthalmology followup.		*if the above conditions are uncomplicated( no corneal perforation, vision loss, endophthalmitis, or other permanent visual threat) these patients may be discharged with next day ophthalmology followup.

2020-11-08T14:38:19Z

Background

← Older revision		Revision as of 14:38, 8 November 2020
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	==Background==		==Background==
	*Contact lens wearers are at increased risk of unique ocular complications. A thorough ophthalmic exam should be performed in patients presenting with ocular complaints.		*Contact lens wearers are at increased risk of unique ocular complications. A thorough ophthalmic exam should be performed in patients presenting with ocular complaints. <ref>The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. Philadelphia: Lippincott, 1994.</ref>
	*Mechanisms of complications include<ref>https://eyewiki.aao.org/Contact_lens_complications</ref>:		*Mechanisms of complications include<ref>https://eyewiki.aao.org/Contact_lens_complications</ref>:
	**Direct trauma		**Direct trauma

2020-11-08T14:33:55Z

Disposition

← Older revision		Revision as of 14:33, 8 November 2020
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	==Disposition==		==Disposition==
			*if the above conditions are uncomplicated( no corneal perforation, vision loss, endophthalmitis, or other permanent visual threat) these patients may be discharged with next day ophthalmology followup.

	==See Also==		==See Also==

2020-11-08T14:11:48Z

Management

@@ Line 44: / Line 44: @@
 ==Management==
+*Corneal Ulceration- Infiltrate + epithelial defect + Anterior chamber reaction + Pain
 ==Disposition==

2020-11-08T13:57:39Z

Evaluation

@@ Line 28: / Line 28: @@
 ==Evaluation==
+*History
 ==Management==

2020-11-08T13:33:17Z

Background

← Older revision		Revision as of 13:33, 8 November 2020
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	==Background==		==Background==
			*Contact lens wearers are at increased risk of unique ocular complications. A thorough ophthalmic exam should be performed in patients presenting with ocular complaints.
	*Mechanisms of complications include<ref>https://eyewiki.aao.org/Contact_lens_complications</ref>:		*Mechanisms of complications include<ref>https://eyewiki.aao.org/Contact_lens_complications</ref>:
	**Direct trauma		**Direct trauma

2020-11-08T13:31:07Z

Differential Diagnosis

← Older revision		Revision as of 13:31, 8 November 2020
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	==Differential Diagnosis==		==Differential Diagnosis==
	''Contact lens wearers are at increased risk of:''		''Contact lens wearers are at increased risk of:''
	*~~[[Bacterial keratitis]]~~, ~~[[Herpes keratitis]]~~, ~~fungal~~ and ~~parasitic keratitis<ref>https://www.cdc.gov/contactlenses/germs-infections.html</ref>~~		*Infectious corneal infiltrate or ulceration
	*[[Keratoconjunctivitis]]		**bacterial(pseudomonas in particular), fungal, and acanthamoeba
	*~~[[Pseudomonas]] [[bacterial conjunctivitis\|conjunctivitis]]~~		*Keratoconjunctivitis
			*Hypersensitivity to contact lens solution
			**often secondary to a new solution or inadequate lens rinsing
			*Contact lens induced Giant Papillary Conjunctivitis
	*[[Allergic conjunctivitis]]		*[[Allergic conjunctivitis]]
	*[[Corneal abrasion]]
	*[[Corneal ulcer]]
	*Corneal edema, distortion		*Corneal edema, distortion
	*Sterile infiltrates		*Sterile infiltrates
	*Neovascularization		*Neovascularization
			*Displaced contact lens
			**if displaced it is usually in the superior fornix

	==Evaluation==		==Evaluation==

2020-11-08T13:21:03Z

Clinical Features

← Older revision		Revision as of 13:21, 8 November 2020
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	==Clinical Features==		==Clinical Features==
	*Presentation of various problems may be complicated by hypoesthesia in chronic contact lense wearers		*Presentation of various problems may be complicated by hypoesthesia in chronic contact lense wearers
			**Pain, photophobia, foreign body sensation, decreased visual acuity, discharge, and burning are common.

	==Differential Diagnosis==		==Differential Diagnosis==

2019-10-05T15:55:13Z

Differential Diagnosis

← Older revision		Revision as of 15:55, 5 October 2019
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	==Differential Diagnosis==		==Differential Diagnosis==
			''Contact lens wearers are at increased risk of:''
	*[[Bacterial keratitis]], [[Herpes keratitis]], fungal and parasitic keratitis<ref>https://www.cdc.gov/contactlenses/germs-infections.html</ref>		*[[Bacterial keratitis]], [[Herpes keratitis]], fungal and parasitic keratitis<ref>https://www.cdc.gov/contactlenses/germs-infections.html</ref>
	*[[Keratoconjunctivitis]]		*[[Keratoconjunctivitis]]