Rigid Gas Permeable Lenses Complications and Management Contact lenses are used to correct refractive error, improve visual acuity, and enhance appearance for cosmetic reasons. RGP lenses can provide sharper vision correction than soft lenses for a few different reasons. First of all, they won't dry out and fluctuate in shape the way soft lenses can. Gas permeable lenses are custom-made to have a smooth surface and hold their shape on the eye. The wear of RGP contact lens can damage normal physiological function of tears and aggravate dry eyes. These slides describe the Complication of RGP lenses and required Management

1. RGP
Complications
and Management
Rabia Bushra Ehsan

2. Contact lenses are used to correct refractive error, improve visual acuity, and
enhance appearance for cosmetic reasons.
Improper use of contact lenses can cause numerous complications, which are
manifested in various clinical signs and symptoms.
About 4% of patients suffering from ophthalmic problems bear contact lens
complications
Introduction

3. COMPLICATIONS

4. 3 & 9 O’clock staining
● Peripheral corneal desiccation (PCD) or 3 and 9 o’clock staining is the
horizontal drying of the cornea or on the adjacent conjunctiva displaying a
hallmark fluorescein stain.
● Most common in RGP EW rather than DW

6. Management
● Patient education
● Tear supplements
● Improve blinking
● Redesign lens to improve fitting
● Use large diameter (TDs of 9.6 & 10.2 mm) lenses to provide wide tear
reservoir at lens edge

7. Corneal Dellen
● Dimples or saucer-like excavations at the corneal margin that are usually
elliptical in shape and parallel to the limbus
● Fluorescein and Rose Bengal pool in the dellen, there is no true staining
because the epithelium in the depression remains intact
● They are thought to occur due to localized tear film instability especially
the mucin layer and dehydration.

9. Management
● Any 3 & 9 O’clock staining should be minimized
● RGP lens fitting characteristics should be optimized
● Temporary discontinuation of lens wear allows the cornea to
recover to normal thickness by re-epithelialization

10. Corneal oedema
● Corneal edema is swelling of the cornea
● Corneal edema can also occur following over-night wear of certain
types of contact lenses
● Corneal oedema is very subtle with RGP materials
● Corneal edema is a risk of Keratopathy

12. Management
● Maximize the oxygen availability to the eye
● Optimizing the level of oxygen transmissibility
● In cases of EW, reduce the wearing time so that the adverse effects are
minimized

13. Vascularized Limbal Keratitis
● It is seen as an elevated, semi-opaque epithelial lesion with adjacent
epithelial staining and neovascularization.
● The neovascularization starts limbally and grows further into the central
cornea.
● It typically occurs in patients with a history of daily or extended wear RGP
contact lenses

15. Management
In Early Stage VLK
● Discontinue RGP wear temporarily
● Prescribe anti-inflammatory medications
● Refit with new or modified RGP lens parameters.
For Late Stage VLK
● Discontinue RGP lens wear temporarily
● Steroids and Anti-vegf agents are currently the mainstay initial treatment for corneal
neovascularization
● Refit with soft contact lenses.

16. Corneal Warpage
● "Warpage" of the cornea refers to a distortion in the shape of the cornea,
usually due to the use of rigid contact lenses, and especially poorly fitting
rigid lenses.
● The type of lens most notorious for this is the "hard" type of lens, which is
a non-gas-permeable lens made of a plastic called PMMA.
● Apparent cause of corneal warpage with rigid lens is mechanical, the
underlying cause is poor physiology (inadequate lens Dk/t).

18. Management
● Change contact lens material
● Use Silicon hydrogels CL
● Improve physiology (change to lenses with ↑ transmissibility
● Cessation of contact lens

19. Spectacle Blur
Reduced spectacle vision immediately following removal of RGP lenses
Normal vision cannot be restored by altering the spectacle Rx
May improve over time (hours) or after a period of sleep
Blurred vision with spectacles after wearing RGP lenses may be due to
● Change in corneal shape
● Corneal Edema

20. Management
● Educate wearer
● Improve lens fitting characteristics
● Maintain lens mobility
● Increase lens Dk/t significantly

21. Dimple Veiling
● These are Small, hemispherical pits form in the epithelium, resulting in an
irregular corneal surface
● With lens removed, pooling of sodium fluorescein in theses pits presents
Gas bubbles.
● Seen in the cases with excessive corneal clearance Toric cornea with
spherical RGP
● The dimple reduces the cornea’s optical efficacy and reduced vision
results
● If the dimples are located centrally (within the entrance pupil zone), and
are significant in number, vision may be affected

23. Management
● Removing the lenses for a few hours leads to resolution of the dimple
veiling and the associated symptoms
● The treatment of choice is to decrease the optical zone size.
● Alter lens design
● Decrease clearance • Central • edge

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