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Neovascularization, Corneal, CL-related Clinical Presentation

  • Author: Barry A Weissman, OD, PhD, FAAO; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Aug 19, 2015
 

History

Patients are almost always asymptomatic unless the central visual axis is involved.

Patients with CL-induced NV are often aphakic, report a history of sleeping or napping with their CLs on their eyes in an extended wear modality, or report many years of contact lens wear, especially with low oxygen permeability CLs.

Often, a history of poor compliance with proper CL wear (eg, wear extended intentionally or unintentionally through multiple sleep cycles) and care is present. Alternatively, the CLs may be "tight" (eg, restrict tear exchange) or may have low oxygen permeability (eg PMMA lenses or nonsilicone hydrogel CLs).

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Physical

Slit lamp biomicroscopy

NV can be observed in the cornea via slit lamp biomicroscopy. It can be seen in direct illumination or in retroillumination as a continuum of the limbal peripheral vessel arcades. Measuring both the extent and the depth of the corneal NV is important to assist in monitoring this disease. NV can be categorized based on its source (ie, conjunctival, limbal, iris), location, depth, length, branching pattern, color, leakage, and nature of blood flow (ie, presence of corneal hemorrhages).[21, 22]

Limbal hyperemia is the earliest sign of corneal neovascularization.

Superficial vessels emerge in the anterior stroma and appear as single or multiple (pannus) tortuous vessels under low magnification.

Deeper stromal vessels emerge through the cornea as straight vessels that arborize, occasionally accompanied by nerve fibers. They are generally anterior ciliary vessels, appear dark red, and do not raise the epithelium.

Active engorged vessels, occasionally surrounded by lipid exudates and exceeding 1-2 mm in length from the limbus, should raise concern. Active vessels appear bright in color and may have accompanying surrounding corneal edema and leakage.

Lipid deposition appears as yellow-white opacities at the leading edge or surrounding the stromal vessels.

Careful gonioscopy in eyes with deep NV rules out an iris angle choroidal tumor.

NV also should be differentiated at clinical examination from a conjunctival carcinoma extending onto the corneal epithelium.

Ghost vessels have no active blood circulation, represent old corneal neovascularization, and are no longer active.

Measurement of corneal sensation

Measurement of corneal sensation can be helpful in differentiating CL-related NV from a herpes simplex virus (HSV) keratitis (typically reduced sensation with HSV).

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Causes

All CLs (although less so with silicone CLs) can cause NV. This includes daily and extended-wear types of any hydrogel, hard (PMMA), and rigid gas permeable CLs (including orthokeratology CLs) and scleral lenses. NV primarily is related to corneal hypoxia from CL wear and/or chronic corneal desiccation associated with the edges or rigid lenses.

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Contributor Information and Disclosures
Author

Barry A Weissman, OD, PhD, FAAO Professor of Optometry, Southern California College of Optometry; Professor Emeritus of Ophthalmology, Jules Stein Eye Institute, University of California, Los Angeles, David Geffen School of Medicine

Barry A Weissman, OD, PhD, FAAO is a member of the following medical societies: American Academy of Optometry, American Optometric Association, California Optometric Society, International Society for Contact Lens Research

Disclosure: Nothing to disclose.

Coauthor(s)

Karen K Yeung, OD, FAAO Senior Optometrist, Arthur Ashe Student Health and Wellness Center, University of California, Los Angeles

Karen K Yeung, OD, FAAO is a member of the following medical societies: American Academy of Optometry

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Christopher J Rapuano, MD Professor, Department of Ophthalmology, Jefferson Medical College of Thomas Jefferson University; Director of the Cornea Service, Co-Director of Refractive Surgery Department, Wills Eye Hospital

Christopher J Rapuano, MD is a member of the following medical societies: American Academy of Ophthalmology, American Ophthalmological Society, American Society of Cataract and Refractive Surgery, Contact Lens Association of Ophthalmologists, International Society of Refractive Surgery, Cornea Society, Eye Bank Association of America

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cornea Society, Allergan, Bausch & Lomb, Bio-Tissue, Shire, TearScience, TearLab<br/>Serve(d) as a speaker or a member of a speakers bureau for: Allergan, Bausch & Lomb, Bio-Tissue, TearScience.

Chief Editor

Hampton Roy, Sr, MD Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences

Hampton Roy, Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Andrew W Lawton, MD Neuro-Ophthalmology, Ochsner Health Services

Andrew W Lawton, MD is a member of the following medical societies: American Academy of Ophthalmology, Arkansas Medical Society, Southern Medical Association

Disclosure: Nothing to disclose.

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