Edward S. Bennett, OD, MSEd, FAAO, FSLS
Professor Emeritus, University of Missouri St Louis College of Optometry
President and Executive Director



Management of Common
Contact Lens Complications:

Dr. Jennifer Harthan ===========Dr. Michelle Man

On February 18th we were privileged to have a very comprehensive, contemporary presentation on common contact lens complications and their management. Although the presentation was primarily for optometry students and residents, the information provided – including very good graphics – benefits everyone in contact lens practice. It is archived under the “Residents & Students” tab on www.gpli.info. The following includes a summary of the topics presented in this webinar:

I.                  HYPOXIA
=====a.    Corneal Neovascularization
                                                             i.     Causes
                                                           ii.     Management
=====b.    Corneal Edema
                                                             i.     Causes
                                                           ii.     Management
=====c.     Corneal Infiltrates
                                                             i.     Causes
                                                           ii.     Management
=====d.    Important Factors
                                                             i.     Often present with low Dk lens materials; ===============increase Dk (for GPs you can go to the ===============material list on www.gpli.info)
                                                           ii.     Be sure to stain to evaluate for the results of a ===============tight lens (imprint), and staining associated ===============with infiltrates; can change to a flatter BCR or ===============smaller diameter

II.                INFLAMMATION
=====A.   Giant Papillary Conjunctivitis (GPC)
==========a.    Diagnosis
==========b.    Causes
==========c.     Patient symptoms
==========d.    Risk factors:
                                                                                    i.     Infrequent lens replacement, longer wear ====================time, poor lens hygiene, atopy
                                                                                   ii.     High water contact hydrogel material
                                                                                 iii.     Lipid deposits on high modulus Si-HY ====================material
==========e.    Management
                                                                                     i.     Stop CL wear x 4 – 6 weeks
                                                                                   ii.     Artificial tears in mild cases
                                                                                 iii.     Topical mast cell stabilizer/anti-histamine ====================or combination
                                                                                iv.     Short term topical steroid
                                                                                  v.     Switch CL modality (daily disposable) or ====================material
                                                                                vi.     Change solutions (H2O2); enzymatic ====================cleaner (GP)
=====B.    Solution Toxicity
==========a.    Clinical Signs
==========b.    Symptoms
==========c.     Causes
                                                                                     i.     Preservative reaction in MPS system
                                                                                   ii.     H2O2 used improperly
==========d.    Management:
                                                                                     i.     Remove offending agent
                                                                                   ii.     Temporarily d/c CL wear (copious AT use)
                                                                                 iii.     Switch solutions
                                                                                iv.     Review proper care instructions

=====A.   Contact Lens Acute Red Eye
==========a.    Symptoms
==========b.    Clinical Signs
==========c.     Management
                                                                                     i.     D/c CL wear
                                                                                   ii.     Artificial tears
                                                                                 iii.     Steroid or steroid/Ab combination
                                                                                iv.     Change CL modality once resolved
=====B.    Infiltrative Keratitis
==========a.    Symptoms
==========b.    Clinical Signs
==========c.     Management
                                                                                     i.     D/c CL wear
                                                                                   ii.     Lid hygiene
                                                                                 iii.     Artificial tears
                                                                                iv.     Steroid or steroid/Ab combination
                                                                                  v.     Change CL modality once resolved
=====C.    Contact Lens Peripheral Ulcer (CLPU)
==========a.    Inflammatory response: “sterile ulcer”
==========b.    Symptoms
==========c.     Clinical Signs
==========d.    Associations (Gram + bacteria {staph}), extended ===============wear
==========e.    Management
                                                                                     i.     Differentiate from infectious etiology
                                                                                   ii.     D/c CL wear
                                                                                 iii.     Prophylactic antibiotic
                                                                                iv.     Steroid/antibiotic combination
                                                                                  v.     Daily follow-up
                                                                                vi.     Change CL modality once resolved

=====D.   Infectious Chronic Infiltrative Events
==========a.    Microbial Keratitis (Corneal Ulcer)
                                                                                     i.     Defined as a lesion “caused by superficial ====================loss of tissue, usually with inflammation”
                                                                                   ii.     Risk Factors (and questions to ask to ====================determine cause)
====================1.    Eyelid disorders
====================2.    Ocular surface disease
====================3.    Systemic disease/medications
====================4.    Trauma/Surgery
====================5.    Contact Lenses:
=========================a.    Extended wear
=========================b.    Poor personal hygiene
=========================c.     Surface deposits
=========================d.    Non-compliance with ==============================disinfection
=========================e.    Corneal hypoxia with ==============================extended wear
                                                                                 iii.     Common Pathogens
                                                                                iv.     Clinical Signs
                                                                                  v.     Symptoms
                                                                                vi.     Management:
====================1.    Cultures
====================2.    Antibiotic selection (initial broad-=========================spectrum until culture comes =========================back; 1 drop every minute x 5 =========================min.; then every 5 minutes for 15 =========================min; then 1 drop every hour x 24 =========================– 48 hrs. or dual therapy with 2 =========================fortified antibiotics =========================(aminoglycoside, cephalosporin; =========================1 drop q 30 min for first 24 – 48 =========================hrs.)
====================3.    Cycloplegic agent
====================4.    Follow-up within 24 hours
=====E.    Ulcer Versus Infiltrate
==========a.    Pneumonic “PEDAL” (Pain, Epithelial defect, ===============Discharge, Anterior chamber reaction, ===============Location); More pain, bigger epithelial defect, ===============mucopurulent discharge, AC reaction, central ===============location with MK)
==========b.    Very good chart of ulcer versus infiltrate

=====a.    Conjunctival Impression/Staining
                                                             i.     Soft or GP lens edge in tight fit
                                                           ii.     Management:
===============1.    D/c CL
===============2.    Flatter BCR
===============3.    ATs if due to lens drying of tightening ====================syndrome
===============4.    Refit with different edge design
===============5.    Change CL modality
=====b.    Superior Epithelial Arcuate Lesion (SEAL)
                                                             i.     Associated with lens material (stiffer modulus), ===============design, lid force
                                                           ii.     Clinical Signs
                                                         iii.     Symptoms
                                                        iv.     Management
===============1.    D/c CL wear until healed
===============2.    ATs
===============3.    Antibiotic treatment
===============4.    Refit lens
===============5.    Increase frequency of replacement
===============6.    Typically resolves within 24 hours to 1 week
=====c.     Desiccation (smile staining)
                                                             i.     Aka Inferior Epithelial Arcuate Lesion
                                                           ii.     Associations
                                                         iii.     Clinical Symptoms (bilateral, asymmetric ===============arcuate staining 4 & 8 o’clock)
                                                        iv.     Symptoms
                                                          v.     Management
===============1.    D/c CL wear
===============2.    Lubrication
===============3.    Reduce wear time
===============4.    Refit to a lower water content material
=====d.    3 & 9 o’clock Staining
                                                             i.     GP lenses (poor edge, poor tear film, improper ===============blinking, inferior decentration)
                                                           ii.     Clinical Signs
                                                         iii.     Symptoms
                                                        iv.     Management
===============1.    Ocular lubricants
===============2.    Refit GP: Improve centration, change ====================diameter, thinner edge/ultrathin, ====================Lenticular, toric design for higher ====================cylinders
===============3.    Change material: improve wettability
=====e.    Dimple Veiling
                                                             i.     Not true staining but indentations in epithelial ===============due to trapped bubbles
                                                           ii.     Often excessive clearance of a GP lens ===============resulting in “bubble-like” pattern
                                                         iii.     Management
===============1.    Refit into a more alignment fitting lens ====================typically flattening the BCR or ====================decreasing OZD
===============2.    For soft lenses select lens with a lower ====================modulus
=====f.      Foreign-Body Tracking
                                                             i.     Track mark superficial staining of cornea due to ===============trapped debris
                                                           ii.     Management: may simply be an airborne ===============particle and sensation goes away quickly; if ===============recurrent evaluate edge and ensure lens is not ===============damaged

2021 GPLI Monthly Webinar Series

March 16, 2021

OrthoK: Initial Fitting Challenges and Problem-Solving

=====Presented by
Michael J. Lipson, OD, FAAO
8:00 PM Central


April 20: Edward Boshnick OD, FAAO:
Scleral Lens Practice Management

May 18: Karen G. Carrasquillo OD, PhD, FAAO, FSLS, FBCLA: 
Management of the Scleral Lens Ocular Surface Disease Patient Beyond the Fit

June 15: Heidi Miller OD, FAAO, FSLS:
Pediatric Specialty Contact Lens Applications

July 20: Jeff Walline OD, PhD, FAAO: 
Myopia Management Update

August 17: Stephanie L. Woo OD, FAAO, FSLS:
Contact Lens Management of Keratoconus

September 21: Renee Reeder OD, FAAO, FSLS: Custom Soft Lens Update for Healthy and Irregular Cornea Patients

October 19: Jason Jedlicka OD, FAAO, FSLS:
Software Applications for Specialty Lens Designs

November 16: Greg DeNaeyer OD, FAAO, FSLS: Beyond the Basics: Advanced scleral lens design

December 21: Maria K. Walker OD, MS, FAAO, FSLS: GP Material Update


GPLI Resources Spotlight:

Find a GP Specialist

One of the primary resources of the GPLI is the “Find a GP Specialist” module. With almost 3000 eye care professionals (ECPs) in 50 states, it is likely that you can find one or more GP specialists to refer a patient to. The specific ECP as well as their practice name, location, phone number, and web site are typically listed. In addition, their areas of specialties are also listed including the following:
=====1)   General GP Contact Lenses
=====2)   Bifocal/Multifocal Contact Lenses
=====3)   Corneal Reshaping/Orthokeratology
=====4)   Contact Lenses for the Irregular Cornea
=====5)   Scleral Lens Designs

There is also the option to sign up online to be a referral practitioner. The resource has recently been revised but if you notice any errors or updates please email Pam Witham at [email protected] and provide the updated or corrected information. 

The GPLI Recognizes:

Dr. Daniel Fuller as the first recipient of the
GPLI Educator of the Year Award.

Orders shipped to the USA only - complimentary

1)   GP Lens Management Guide (download only)

2)   Fluorescein Pattern Identification Card

3)   Correcting Presbyopia Tips Card

4)   Contact Lens Clinical Pocket Guide

5)   In-Office Disinfection of Multi-Patient Use Diagnostic Contact Lenses

6)   See with Your Contacts Even When You’re Not Wearing Them (Orthokeratology Patient Brochure which can be downloaded as well)

7)   Look as Young as You Feel (Multifocal Patient Brochure which can be downloaded as well)

8)   Scleral Lenses are Big News (Scleral Consumer Brochure which can be downloaded as well)

9)   Caring for Your GP Lenses (Care and Handling Patient Brochure which can be downloaded as well)

10)   Myopia Management (Myopia Patient Brochure for which the references can be downloaded from this site)

11)  Reading Verification Card (features both passages on one size of varying acuity and different types of print – newspaper, etc. – on the other side)

12) Scleral Lens Care Tips, Application and Removal Card

Our contact lens industry is growing thanks to each of us connecting with each other, hoping for the best and believing in what we do!!

GP Lens Institute

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(800) 344-9060 (USA & Canada)

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