Contact Lens Deposits, Contact lens Aftercare, Overview of care and Maintenance

 

Conatct lens deposit
Any lens surface coating or lens matrix formation which is not flushed or rinsed from the lens by tears during blinking. In effect, anything that remains on the surface despite blinking is deposit.

Deposit Formation:
 Tear protein(lysozyme) are attached to the lens
 Tear evaporates and leave residue on the lens
 After protein are deposited, other components of the tear film (such as mucin) may adhere to protein
 Over time, Layers build up and structural changes take place(e.g. Denaturation)

Factors influencing lens deposition:
o Individual difference in tears
o Lens materials
o Care system
o Wearing schedule
o Environment
o Patient hygiene

Types of Deposits:
1. TEAR RELATED:
• Protein
• Lipid
• Jelly bumps
2. NON-TEAR RELATED:
• Fungi
• Lens discoloration
• Mercurial deposits
• Cigarette residues
• Surface combination
• Rust spots


1. Protein deposits:

• Are a semi-opaque or translucent film usually thin whitish and superficial
• Have a frosted glass appearance
• may cover lens surface partially or full
• Cause the lens surface to become hydrophobic
• Can crack and peel if thick

Factors favoring a buildup of protein on a contact lens:

• short BUT
• Ionic binding capacity
• Inadequate cleaning especially of the lens periphery
• Altered blinking
• Heat disinfection
• Tear deficiency or altered tear composition
• Chronic allergies and GPC

2. Lipid Deposits
• Appears as greasy, smooth, and shiny adherent films on both RGP and soft contact lenses
• Best observed between blinks
• Appears as a thick
• oily coating

Lipids involved includes:
• phospholipids,
• neutral fats,
• triglyceride,
• cholesterol,
• cholesterol esters,
• fatty acids

Origin: mainly from meibomian gland

Predisposing factors:
• Tear film quality
• Slow blink pattern
• Poor lens compliance
• Careless use of inappropriate cosmetics/lotions


3. Jelly Bumps

• Appear as a clump of raised translucent mulberry like deposits
• Typically form in inferior
• exposed portion of lens
• Occur more frequently in high water, ionic, EW lenses

Predisposing factors

• Quality of tear film
• Poor blinking
• Lens surface contamination

• Aphakia cleaning consequences
• Large and numerous jelly bumps lead to wearer discomfort
• Large deposits can cause the lens to attach to the upper lid so that each blink causes excessive lens movement
• When located within pupil zone-visual acuity can fluctuating
• Maya also cause mechanical irritation of tarsal conjunctiva
• In extreme case, may cause CLPC

4. Inorganic Deposits
• Calcium carbonate deposits
• Calcium phosphate deposits
Appearance:
• White crystalline specks
• Can be small or large
• Rough surface
• Penetrate lens surface if severs









5. Fungal Deposits
Appearance:
• Filamentary growth on and into lens
• Usually white, brown or black

Fungal formation
• Spores on lens surface from eye or environment
• Proliferates to large visible growth

1. CONTACT LENS

Contact lens deposit types, Care of CL, Aftercare
of CL, Maintenance – method if disinfection
Maryam Fida
(o-1827)

2. Conatct lens deposit
Any lens surface coating or lens matrix formation which is not flushed or rinsed from the
lens by tears during blinking. In effect, anything that remains on the surface despite blinking is
deposit.

Deposit Formation:
 Tear protein(lysozyme) are attached to the lens
 Tear evaporates and leave residue on the lens
 After protein are deposited, other components of the tear film (such as mucin) may
adhere to protein
 Over time, Layers build up and structural changes take place(e.g. Denaturation)

Factors influencing lens deposition:
o Individual difference in tears
o Lens materials
o Care system
o Wearing schedule
o Environment
o Patient hygiene

Types of Deposits:
1. TEAR RELATED:
 Protein
 Lipid
 Jelly bumps
2. NON-TEAR RELATED:
 Fungi
 Lens discoloration
 Mercurial deposits
 Cigarette residues
 Surface combination
 Rust spots

3. 1. Protein deposits:

 Are a semi-opaque or translucent film usually thin whitish and superficial
 Have a frosted glass appearance
 may cover lens surface partially or full
 Cause the lens surface to become hydrophobic
 Can crack and peel if thick

Factors favoring a buildup of protein on a contact lens:

 short BUT
 Ionic binding capacity
 Inadequate cleaning especially of the lens periphery
 Altered blinking
 Heat disinfection
 Tear deficiency or altered tear composition
 Chronic allergies and GPC

2. Lipid Deposits
 Appears as greasy, smooth, and shiny adherent films on both RGP and soft
contact lenses
 Best observed between blinks
 Appears as a thick
 oily coating

Lipids involved includes:
 phospholipids,
 neutral fats,
 triglyceride,
 cholesterol,
 cholesterol esters,
 fatty acids

Origin: mainly from meibomian gland

Predisposing factors:
 Tear film quality
 Slow blink pattern
 Poor lens compliance
 Careless use of inappropriate cosmetics/lotions

4. 3. Jelly Bumps

 Appear as a clump of raised translucent
mulberry like deposits
 Typically form in inferior
 exposed portion of lens
 Occur more frequently in high water, ionic,
EW lenses

Predisposing factors

 Quality of tear film
 Poor blinking
 Lens surface contamination

 Aphakia cleaning consequences
 Large and numerous jelly bumps lead to
wearer discomfort
 Large deposits can cause the lens to attach to the upper lid so that each blink causes
excessive lens movement
 When located within pupil zone-visual acuity can fluctuating
 Maya also cause mechanical irritation of tarsal conjunctiva
 In extreme case, may cause CLPC

4. Inorganic Deposits
 Calcium carbonate deposits
 Calcium phosphate deposits
Appearance:
 White crystalline specks
 Can be small or large
 Rough surface
 Penetrate lens surface if severs

5. 5. Fungal Deposits
Appearance:
 Filamentary growth on and into lens
 Usually white, brown or black

Fungal formation
 Spores on lens surface from eye or environment
 Proliferates to large visible growth
 Penetrate lens matrix
 Contact lens good medium for fungal growth

6. Mercurial deposits:
 Appear as a greyish to black discoloration
 Reuse of thimerosal containing solution is one cause

To prevent avoid mercury based preservatives

Ageing
 Polymer breakdown
 Chemical absorption
 Handling
 Stress and strain
 Deposition

Surface contamination
 Make up
 Moisturizing lotions
 Hairspray
 Chemical fumes

Management
 Advice patient on good hygiene
 Proper care and maintenance
 Do not reuse solutions
 Smokers should be warned

6. 7. Rust spots

Appearance:
 Small superficial raised spots
 Colored orange to black
 Can be few to numerous






















Care of contact lenses

 Hands should be cleaned before handling CL
 Never apply pressure
 Before insertion, must be cleaned spotlesly
 Clean upon removal
 For cleaning, use cold water or Antiseptic wetting agent
 Before insertion , CL should be rinsed with sterile Saline.
 Pt shouldn’t sleep or swim in CL

7. Insertion and removal of CL
 INSERTION:
Technique 1
 Place wet lens hollow side on the end
of middle finger of Right hand
 Pull lower lid downward and hold it
firmly
 Place left hand over head and place
forefinger toward middle of margin of
right upper lid
 Pull upper lid up and hold it firmly
 Insert the lens
 To insert lens in Left eye, one can use
same way or alternate way.

Technique 2
 Spread the forefinger and middle finger
of right hand in the form of an open
pair of scissors
 Hold lower lid down with middle finger
 Hold upper lid up with forefinger
 Place the lens with its hollow side up
on forefinger of left hand
 For fellow eye, same or alternate way

8. Removal of CL
TECHNIQUE 1
 Bend over
 Cup left hand under right eye
 Place thumb of right hand at outer corner of eyelid
 Look straight and down with opening of wide eyes
 Pull the finger in upward and outward direction
 Opposite hand use for fellow eye
Technique 2
 Bend over
 Place middle finger of right hand along with right lower lid
 Forefinger of right hand along upper lid margin
 Cup left hand under right eye to catch lens
 Draw lid away from lens
 Press tightly looking straight ahead
 Alternative method for another eye

Disinfection
 a dynamic process,
 usually preceded by a cleaning and rinsing step,
 intended to kill and/or remove microbial and viral contaminants from contact lenses.

Methods:

1. Heat-based disinfection systemsuse heat in
the range from 70°C to 125°C to kill or deactivate
living lens.
2. Chemical disinfection systemsin the chemical
systems category is the current hydrogen peroxide
and multi-purpose solutions.

9. Contact lens Aftercare:
 Personal hygiene
 Dry hands
 Clean and clipped finger nails
 Soap or base usage should be avoided

 Storage of lens
 Store in dry state
 In simply shaped preferably flat case
 Cleaned at least every week

 Routine cleaning
 Usage of wetting solution
 Wash with water
 Saline

 Enzyme cleaning
 Papain enzyme for cleaning once a week
 Left lens in solution for 4 hours

 Removal of lens
 Washing of hands with soap before removing then dried
 Cleaning of lens before storage