For this exercise (Optician 03.07.15), you were asked to look carefully at six sets of case notes, and the accompanying images, and then answer the two questions for each case. For this particular exercise the CCLRU (BHVI) Grading Scale (Figure 1) was provided.
[CaptionComponent="1746"]Case 1
Routine aftercare visit; long term wearer of over 25 years of conventional hydrogel lenses; low myope (-1.75DS); current lenses monthly disposable; wearing times 14-16 hrs every day. Acuity is ‘excellent’, no discomfort, aware of increasing redness for last few months. Care system used 1 step hydrogen peroxide. Lenses good fit, no corneal staining. General health good.
Q What is the most likely cause of the redness?
A Contact lens over wear
Q Grade level of bulbar hyperaemia seen in the image
A Bulbar Grade 2.5
Case 2
Single use daily disposable lens wearer; wearing time 16 hours every day. Comfort and vision reported to deteriorate as each day progresses; occasional use of re-wetting drops.
Q What is the most likely cause of the staining shown?
A Contact lens removal technique
Q Grade the level of staining (both type and extent) seen
A Staining Type Grade 3.5 / Staining Extent Grade 2.5
Case 3
Routine aftercare visit; long term RGP wearer; wearing time 16 to 17 hours every day; current lenses over 2 years old; acuity excellent; no discomfort.
Q What is the most likely cause of the staining shown?
A Foreign body staining
Q Grade the level of staining (both type and extent) seen
A Staining Type Grade 2.0 / Staining Extent Grade 2.0
Case 4
1 week follow up visit after fit with new pair of silicone hydrogel daily disposable contact lenses; wearing time 4 hours maximum, 2 days of the week; finds new lenses uncomfortable; history of trying numerous brands single use daily disposable lenses and had similar symptoms
Q What is the most likely cause of the staining shown?
A Lagophthalmos
Q Grade the level of staining (both type and extent) seen
A Staining Type Grade 2.5 / Staining Extent Grade 2.0
Case 5
Overdue annual check; high myope (-9.00DS); increased awareness of lenses for last few weeks; slight stringy discharge; wearing times 14 to 16 each day; silicone hydrogel monthly lenses and multipurpose solution care system purchased via internet – unsure of type or brand; current lenses approximately 6 weeks old
Q What is the most likely cause of the lid appearance?
A Contact Lens Associated Papillary Conjunctivitis (CLAPC)
Q Grade the level of hyperaemia and roughness seen?
A Redness Grade 4.0/Roughness Grade 4.0
Case 6
Routine 6 month follow up visit; recently refitted with silicone hydrogel monthly disposable contact lenses; wearing time 10 hours maximum 5 days a week; finds new lenses less comfortable than previous hydrogel monthly lenses; fit acceptable.
Q What is the most likely cause of the staining shown?
A Superior epithelial arcuate lesion (SEAL)
Q Grade the level of both corneal staining type and conjunctival staining seen above
A Corneal Staining Type Grade 2.0/Conjunctival Staining Grade 3.0
Some Final Key Learning Points
- Review your record-keeping recording techniques to ensure they reflect ‘good practice’
- Adopt standard grading scales for you and your colleagues to use
- Always record the specific grading scale used
- Have the scale visible and refer to it at all times — do not try to guess from memory!
- Consider a sketch or photograph in addition to using a grading scale
Caroline Christie is an independent optometrist specialising in contact lenses