Anatomy

1. Contact lenses Week 2 Anatomy

2. Anatomy • Tear film consists of three layers with a pH level of 7.3 and a salt concentrations of 0.91 to0.97%. Normal evaporation is 1 to 2 microliters or 15% of total volume per minute.

3. Anatomy • Three layers of the tear film • Oily layer • Aqueous layer • Mucous layer

4. Anatomy The oily layer • The outermost layer of the pre corneal tear film. • Consists of a lipid layer that is a partially solid oil and wax that helps to stabilize the tear film and prevent evaporation. • This oily layer is produced by the meibomian glands. • An insufficient amount of the oily layer will cause dryness, pingueculae, pterygium and scarring.

5. Anatomy The aqueous layer • The middle layer of the tear film. • This layer is made of salt, sugars, urea and protien. • Lactoferrin (an iron carrying protien) supports oxygen transfer and has significant bacteria inhibiting characteristics. • The aqueous layer is produced by the lacrimal gland.

6. Anatomy The mucous layer • The innermost layer of the tear film and also the thinnest. • The corneal surface in hydrophobic(water fearing) • The mucin layer reverses the hydrophobic characteristic of the epithelium to hydrophilic (water loving). • The mucin layer also is produced by the conjunctival goblet cells.

7. Anatomy Tear film

8. Anatomy Cornea 5 layer of the cornea Epithelium Bowman’s layer Stroma Decemet’s membrane Endothelium • The cornea consists of 5 layers. • The cornea is the most powerful refracting surface of the eye, with an average diopteric power of 48.8.

9. Anatomy • Corneal epithelium • 5 to6 cell layers thick.( 50-60 microns thick) • This layer acts as a barrier the foreign bodies and friction during blinking. • Disturbances to the epi can be directly linked to a CL that reduces the amount of O2 to the cornea. • Decemet’s membrane • Produced by the endothelium. • Corneal endothelium • Single layer of cells. • Endothelial cells can not regenerate. • Acts as a pump to maintain dehydrated cornea.

10. Anatomy Corneal layers Layers under the slit lamp

11. Anatomy • Blinking spreads the tear film of the cornea. This is critical to the success of the contact lens wearer. • The eyelids spread the tear layer over the cornea by blinking an average of 7 times per minute. • This will increase to 18-20 times per minutes after the initial insertion of the CL. • Lens material can affect the blink rate. If this is altered, it will cause lens dehydration and discomfort.

12. Anatomical disorders and contraindications for CL wear. • Tear dificiencies • Dry eye • Sjogren’s syndrome • Blepharitis • Entropian • Ectropian • Trichiasis • Lagophthalmos • Scleritis or episcleritis • Keratoconus • Diabetes • Grave’s disease • pregnancy

13. CL contraindications trichiasis entropian

14. LC contraindications Floppy eyelid syndrome

15. CL Contraindications Grave’s disease ectropian

16. CL Contraindications scleritis scleritis

17. CL Contraindications Dry eye with staining Dry eye with punctate staining

18. CL Contraindications keratoconus keratoconus

19. Slit lamp examination This microscope with its high intensity lamp is critical for checking movement and the centering of a contact lens. Evaluating fluorescein patterns is much easier when checking the fit a CL. Tear film, corneal surface and tear break up time is evaluated with the slit lamp as well to see if the patient is a good candidate for CL’s.

20. Tear assessment testing • Tear flow • Schirmer • Hypofluorescence • Tear stability • TBUT • Evaluation of lipid layer • Condition of ocular surface • Fluorescein staining • Rose bengal

21. Tear assessment Tear quality / tear break up time test Tear quantity /schirmer testing

22. The end! • See you next week for soft CL basics and care products lecture. • Test in two weeks!