is an often overlooked player in contact lens management. An
important part of any baseline slit lamp examination should include
a thorough examination of the eyelids. This includes both the eyelid
margins and the palpebral conjunctiva, particularly the superior
tarsal plate. The eyelid margin is a hotbed of metabolic activity.
Meibomian glands produce oil into the tear film and onto the ocular
surface. cludes both the eyelid margins and the palpebral
conjunctiva, particularly the superior tarsal plate.
eyelid margin is a hotbed of metabolic activity. Meibomian glands
produce oil into the tear film and onto the ocular surface.
Disorders at the margin can adversely effect these functions.
production leads to rapid tear breakup. This predisposes the contact
lens wearer to experience dryness and/or rapid lens surface
eyelid margin pathology results from bacteria feasting on the oil
deposits on the lid margin. In addition to compromising oil
production, these bacteria produce exotoxins that can lead to
corneal complications such as marginal infiltrative keratitis.
signs to look for are thickened, scalloped lid margins with pouting
glands or oil caps at the meibomian gland openings.
scrubs and warm compresses (outside therapy working in) combined
with an oral agent such as doxycycline (inside therapy working out)
can provide dramatic improvement.
Make Lid Eversion Standard
of the upper eyelid allows for examination of the superior tarsal
plate. Make this procedure standard when examining a patient who's
wearing or considering contact lenses. Look for generalized changes
suggestive of seasonal allergies. If noted, be proactive and
prescribe anti-allergy therapy. More isolated areas of change of the
superior conjunctiva is a sign of mechanical irritation from a
contact lens edge or from blinking over a soiled lens surface
Figure 1. Superior tarsal
plate changes resulting
from edge irritation from
a high modulus silicone
to examine the superior tarsal plate can lead to unnecessary and
ineffective approaches to solving persistent problems of discomfort
and rapid contact lens spoilage. It only takes a moment and can save
aggravation and embarrassment. Once discovered, you can effectively
manage GPC with temporary lens discontinuation, topical
antihistamine/mast cell stabilizers and/or topical steroids and the
use of daily disposable lenses.
eyelid position relative to the upper limbus plays a major role in
GP lens fitting. An eyelid that covers the upper limbus allows for a
lid attachment fit in which the upper lens edge tucks under the
eyelid. Because the lid margin doesn't pass over the lens edge with
each blink, this approach improves comfort.
course, lower lid position is important when fitting a translating
GP bifocal. Ideally the lower lid would lie tangential to the lower
limbus to support the lens adequately. A lower lid that covers the
lower limbus may be acceptable, but you may have to limit the near
segment size to fit it between the lower pupil and the lower lid. A
bottom lid that lies below the lower limbus precludes translating
your mission to be vigilant about assessing eyelid condition and
position when examining a lens candidate or current wearer. This
approach will help you avoid potential problems and solve existing
complications efficiently and effectively.