A Guide to Clinical Contact Lens Management

Signs, Symptoms, Diagnosis and Management

Academy for Eyecare Excellence™
IN COOPERATION WITH
Centre for Contact Lens Research
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Microcysts and vacuoles

Corneal Microcysts and Vacuoles

Symptoms

  • Generally none
  • May be mild irritation or hazing of vision

Signs

  • Microcysts show reversed illumination in marginal retro illumination (higher refractive index of necrotic cells)
  • Vacuoles show non-reversed illumination and are larger and more rounded
  • Punctate staining may be seen

Etiology

  • Microcysts are incompletely formed cells which move through the epithelium with normal cellular turnover
  • Due to chronic hypoxia. Typically take several months to occur
  • Can also be seen in non-CL wearers
  • Small numbers of microcysts in a CL wearer is considered normal
  • Vacuoles are fluid filled spaces due to chronic hypoxia

Prevalence

  • Occasional

Differential Diagnosis

Management

  • Change to high Dk/t lenses, reduce the number of nights wear/week if EW, or change to DW or DD
  • May be a temporary increase in microcyst numbers after ceasing EW or changing from low Dk to high Dk EW lens
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