CPO FREE CPO Contact Lens Patient Instruction Questions and Answers 2 — Questions and Answers
Question 1: A patient calls stating their soft contact lens tore while they were removing it, and they believe a piece is still in their eye. What is the MOST appropriate initial instruction?
- "Flush the eye with sterile saline, then look in a mirror. If you see the piece, try to gently slide it to the outer corner of the eye to remove it." (Correct answer)
- "Immediately go to the emergency room, as this is a sight-threatening situation."
- "Use a pair of clean, blunt-tipped tweezers to carefully grasp and remove the fragment from the eye's surface."
- "Rub your closed eyelid vigorously to try and dislodge the piece and work it out naturally."
Correct answer: "Flush the eye with sterile saline, then look in a mirror. If you see the piece, try to gently slide it to the outer corner of the eye to remove it."
The correct initial step is to advise the patient to try non-invasive removal methods first. Flushing with sterile saline can help lubricate and dislodge the fragment. If visible, gently sliding it to the outer corner is a safe technique to attempt removal. Rubbing the eye can cause a corneal abrasion, using tweezers is extremely dangerous, and an emergency room visit is only necessary if these initial, safer steps fail or if the patient experiences significant pain.
Question 2: A patient wearing monthly soft lenses calls with complaints of increasing itchiness, excessive mucus upon waking, and a sensation that the lenses are moving excessively when they blink. What should the paraoptometric advise the patient to do?
- "Switch to a new brand of multipurpose solution immediately."
- "Perform an extra enzymatic protein removal cleaning on the current lenses."
- "Schedule an appointment and discontinue contact lens wear until they can be seen by the doctor." (Correct answer)
- "Apply over-the-counter antihistamine eye drops before and after lens wear."
Correct answer: "Schedule an appointment and discontinue contact lens wear until they can be seen by the doctor."
These symptoms are classic signs of Giant Papillary Conjunctivitis (GPC). The primary and most crucial step is to remove the source of irritation, which is the contact lens. The patient should stop wearing their lenses and schedule an appointment for the doctor to evaluate the condition and determine the appropriate management, which may include a temporary break from wear, a change in lens modality (like daily disposables), or prescribed eye drops. The other options do not address the immediate need to let the inflammation subside.
Question 3: Which of the following instructions is specific and critical for a new scleral lens wearer regarding the disinfection process?
- "You must use a hydrogen peroxide-based system and allow the lenses to neutralize for a minimum of six hours before insertion." (Correct answer)
- "It is acceptable to top off the multipurpose solution in the case for up to three days before replacing it."
- "Always rinse your scleral lenses with tap water before filling them with saline and inserting them."
- "Store the lenses dry overnight to prevent bacterial growth and rehydrate them in the morning."
Correct answer: "You must use a hydrogen peroxide-based system and allow the lenses to neutralize for a minimum of six hours before insertion."
Hydrogen peroxide systems are frequently recommended for deep cleaning scleral lenses. It is critically important that the peroxide is fully neutralized, a process that takes at least six hours, before the lens is placed on the eye to avoid a painful chemical burn. Topping off solution, using tap water, and storing lenses dry are all dangerous practices that can lead to contamination and serious eye infections.
Question 4: A patient who wears daily disposable lenses is going on a beach vacation and asks for the best advice on swimming in the ocean. What is the safest and most practical instruction?
- "Wear your daily lenses as usual, but be sure to rinse them with fresh water after swimming."
- "It's safest to wear well-fitting, waterproof swim goggles over a fresh pair of daily disposables, and discard the lenses immediately after swimming." (Correct answer)
- "Switch to monthly lenses for the trip, as they are thicker and less likely to be lost in the water."
- "Close your eyes tightly underwater to form a natural seal, which is sufficient to protect the lenses."
Correct answer: "It's safest to wear well-fitting, waterproof swim goggles over a fresh pair of daily disposables, and discard the lenses immediately after swimming."
The safest practice is to avoid wearing contact lenses while swimming. However, if a patient must wear them, the recommended approach is to use daily disposables, as they can be discarded immediately after swimming, minimizing exposure to contaminants. This should always be paired with waterproof swim goggles to create a barrier between the eye and the water, which contains harmful microorganisms like Acanthamoeba.
Question 5: When instructing a patient on handwashing prior to lens handling, which of the following substances is MOST important to avoid in a soap because it can adhere to the lens surface and cause irritation or cloudy vision?
- Antibacterial agents
- Saline
- Lanolin or other oil-based moisturizers (Correct answer)
- Chlorine
Correct answer: Lanolin or other oil-based moisturizers
Patients should be instructed to use mild, basic soap without oils, lotions, or heavy fragrances. Lanolin, a common ingredient in moisturizing soaps, is an oily substance that can easily transfer from the fingers to the contact lens, causing a greasy film that is difficult to clean and results in blurred vision and discomfort.
Question 6: A patient calls in a panic, stating their soft lens has folded and slid under their upper eyelid and they cannot see it. Which technique should the paraoptometric instruct the patient to try first?
- "Use a cotton swab to sweep under the eyelid and retrieve the lens."
- "Gently pull the upper eyelid out and down over the lower eyelid while looking down."
- "Instill rewetting drops, close the eye, and gently massage the closed eyelid to move the lens back into position." (Correct answer)
- "Immediately flush the eye with a high-pressure stream of water to dislodge it."
Correct answer: "Instill rewetting drops, close the eye, and gently massage the closed eyelid to move the lens back into position."
When a soft lens is displaced, it has often become dehydrated and stuck. The first step is to re-lubricate the eye and lens with approved rewetting drops or sterile saline. After lubricating, closing the eye and gently massaging the lid can help float the lens and move it from under the eyelid back to a position on the cornea where it can be removed normally. Using foreign objects like cotton swabs or high-pressure water is dangerous, and the eyelid-over-eyelid technique is less effective for a lens stuck high up.
CPO FREE CPO Contact Lens Patient Instruction Questions and Answers 2
A patient calls stating their soft contact lens tore while they were removing it, and they believe a piece is still in their eye.
What is the MOST appropriate initial instruction?