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Anatomical
Considerations
Although this course is entitled Anatomical Considerations, it might
just as easily be called Potentially Adverse Effects of Contact Lens
Wear. In effect, this course catalogues many of the potentially negative
aspects of contact lens wear. However, with diligence on the part of
the fitter and compliance on the part of the patient, many of these
adverse effects can be greatly minimized. Proper patient selection,
well-fit lenses, and adequate follow-up will usually result in healthy
corneas and satisfied patients. However, lack of concern, laziness,
or simple negligence on the part of either the fitter or the patient
can often cause the sort of problems we're about to study. Detecting
many of these conditions will often require considerable clinical experience,
and treating them should always be left to the prescribing practitioner.
The course begins with a review of certain anatomical structures which
effect the contact lens fitter. These include the tear film, eyelids,
conjunctiva, cornea, and limbus. It is followed by a presentation of
some of the potentially adverse effects of contact lens wear which include
corneal edema, corneal striae, conjunctival and episcleral injection,
giant papillary conjunctivitis, and corneal vascularization. Flourescein,
in addition to its value in helping to evaluate the fit of a contact
lens, is also used to facilitate the precise delineation of specific
corneal epithelial defects. It acts either by pooling in the area of
the defect or by staining the underlying exposed basement membrane or
Bowman's layer. Corneal epithelial staining patterns could possibly
be caused by direct trauma or by defective distribution of the tear
film. This section will illustrate staining patterns which might be
caused by a poorly edged or damaged lens, or by improper insertion,
removal and recentering techniques. We will also discuss staining which
might be the result of defective tear distribution such as "three and
nine-o-clock" staining, or limbal peripheral staining. This course will
conclude with a discussion of the biomicroscope or slit-lamp and will
emphasize the importance of this instrument in contact lens fitting.
The various illuminations are discussed, illustrated, and the uses of
each are described.
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