RGP contact lens always getting dirty

[RKM]

Hi

I have a client that was a soft contact lens wearer. Her best corrected VA was 20/25 with soft lenses. I switched her to RGP lenses and she is now at 20/15 with sharp vision. However there is two problems that I am hoping somebody can help me with:

1. Here eyes are itchy.

2. The lens keep depositing around the periphery zones.

Whats happening?

I have redone the left lens her eye is less itchy. Her right lens I am redoing. (She does not feel the right lens in her eye but it is depositing.

RKM

[chip anderson]

Possibly poorly surfaced edges, any lathe marks (many labs don't take peripheral lathe marks seriously), and disturbance on the surface will irritate lids cause mucous secretions and give it a place to hold on. Poor lenticulation, or abrupt C.N. Bevel can do same.
Poor wetting, hands should be washed with ivory bar soap. Lens should be rubbed (no matter what the damn bottle says) with wetting (conditioning) solution and dipped in tap water (not rinsed off under the tap).
Lenses should be cleaned with HGP lens cleaner and friction and rinsed in a bowl of water before storage. Lenses should never be allowed to dry out.
Lenses should be enzymed with enzymatic cleaner weekly.
Check lenses for deposits on lens which can cause it to lock on cornea like a keratoconnus lens fitted too steep/large. If found polish anterior and posterior.
Now to why not rinsed under the tap. Fully 80& of the patients I have seen with rigid lens problems that occur after successfull fitting and follow-up are due to the patient scratching the lenses when removing them from the sink after dropping them. Of course 90% of them will tell you they never drop them.
Soaps with oils, creams, or any other miracle ingredients should not be used.
Lenses should be placed on the eye prior to applying make up.

Chip.

Other possible problems: Patient does not blink completely ( 20x min for females, 17x min for males).
Non-rotating lens as toric or prism ballasted bifocal, will collect stuff at 180, I don't have a solution for this.
If patient has a bad case of giant papillary conjunctivitus, this should be better with RGP but could be the cause of the itching and a lot of the mucous, evert the lid and look.

[Dave Nelson]

Lid eversion ASAP. Is the lens dragging with the blink?

[RKM]

Thanks!

There is minor GPC. The lens on blink does not drag.

If there is too much or to little edge lift can that cause deposits?

[Dave Nelson]

Hi Raj.Some deposits accumulate where the lens edge lifts, because there is no mechanical "scrubbing" of the lens edge as there is with the rest of the lens. Itching is the hallmark for allergies, so they should be strongly suspected. Does the itching worsen with lens removal?

[RKM]

Hi David,

When she removes the lens her eyes itch more. Is that allergies?

[Dave Nelson]

usually GPC.

[chip anderson]

If the lens doesn't move freely with blink, it has a layer of encrusted deposits. Will lock in place, probably feel comfortable but eye will be swollen, leave flouresein imprint of lens on removal and have diffuse stains centrally. Polish or replace. Also note when you have a colored lens (except a few discontinued plastics that would turn from brown to gray in a year) and it is no longer the same color, this is deposits. If lens appears yellow after flouresien (even after being blotted dry) it's deposits. If it doesn't appear bright and shinny after cleaning it's deposits.
Can also be seen with good illumination and magnification off eye, sometimes on eye.
Deposits will cause: Locking in place, GPC, discomfort, itching, blurred vision with spectacles after removing lenses. Distorted K readings, etc.

Have you checked for all the above?

Chip

[RKM]

Happy New year!

Thanks for all your feed back. I will be seeing my client next week to refit her OD.

I will be rechecking everything.

[kdpcl]

Hello Raj,

I hear of your same situation several times a week. Most likely the patient is using Boston Solution. I would suggest to your patient to use Optimum GP Solution. Studies show it out performs everything else. Lobob manufactures the Optimum solution. The Optimum solution works differently than all the other more common GP solutions.

Your first comments about the patient was itchiness. Unless the edge of the lens is grossly misshaped, the lens itself is probably not the problem.

A clean lens is a comfortable lens and a more healthy lens. If the patient really does have GPC, OcuSoft lid scrubs will help clear up the symptoms.

I hope this helps.

Keith Parker, NCLEC

www.avtlens.com (http://www.avtlens.com)

[Dave Nelson]

Lid scrubs for GPC??

[kdpcl]

Lid hygiene will be enhanced w/lid scrubs. The new foam lid scrub works very well.

Patients rarely have GPC from wearing GP lenses. The number one complaint was itchiness. GPC is probably there because of dirty soft cls from the past. I have found that symptoms from mild GPC can be lessened with the new foam lid scrubs.

[Dave Nelson]

If lid scrubs help in alleviating mild GPC symptoms, perhaps blepharitis was either the cuase of the problem or an exacerbating factor. Are there any clinical studies to support your assertion or is it anecdotal? I just don't see how a mild soap solution applied to the lid margins have any effect on an auto-immune reaction in the tarsal conjuctiva.
Cheers, David

[kdpcl]

Good morning David,
This comment was purely anecdotal. The patient's chief complaint was itchiness. The number one complaint of GP lens wearers is filmy gritty inconsistant vision. This often blamed on the material or lens manufacturer. When in most cases, a change in solution or compliance habits will alleviate these complaints.

The Ocusoft lid scrubs have been effective in improving lid hygiene and tear chemistry allowing the pt to naturally improve these all too common symptoms.

GPC, again, is very rarely diagnosed from new GP lenses. The point I wanted to make most important in my comments was that the pt's problems are most likely not due to the design of the lens as much as the compliance or their lack of.

Have a good day.

[RKM]

A quick update and thanks.

The lenses are working!

She has GPC and she also has allergies. I did redesign the lens to fix the edge lift (where most deposits were forming). The lens looks good! Her eyes were always red when she wore soft contact lenses. Now her eyes are clear and all her family and friends comment on how good her eyes look. Her itchiness is down to minimal usually right after removal. I did not have to change the solution the Boston appears to be working fine.
:cheers: