Ocular Trauma

BY JIM VERKUILEN, O.D.
JUNE 1996

OCULAR TRAUMA OFTEN PRESENTS UNIQUE CHALLENGES TO THE CONTACT LENS PRACTITIONER. IN THIS CASE, TWO DIFFERENT FITTING PHILOSOPHIES WERE ATTEMPTED.

This 46-year-old male, A.C., was referred for contact lens consultation and management following ocular trauma to the right eye. The photo reveals where a sharp stick penetrated the cornea and subsequently damaged the crystalline lens. Lens extraction was performed and the cornea was sutured. An intraocular lens implant will be inserted upon healing of the cornea and removal of the sutures. We designed a contact lens to provide adequate vision and eliminate aniseikonia during the healing process.

The sutures and healing stromal and epithelial layers caused an elevation with surrounding depression nasally, and general flattening of the central cornea.

Refraction OD revealed: +12.25 -4.25 x 120 with acuity of 20/50.

Keratometric readings OD were 30.00/34.00 compared with OS 43.75/43.75.

We attempted two types of lens fitting philosophies with A.C. First, we tried a very small lens design to fit inside the sutured area. The base curve was 10.55mm with an 8.0mm diameter. This lens was very unstable and decentered temporally.

With the second design, we increased the lens diameter to vault the sutured area, and we calculated the base curve from the K readings of the fellow eye. The lens specifications were: FluoroPerm 60, base curve 7.71, diameter 11.0. The lens provided adequate tear exchange. There was inferior decentration, but the lens did not compromise corneal physiology, vision or patient comfort. Visual acuity was 20/20-2 with this design.

We prescribed polycarbonate safety glasses with a bifocal correction for the right eye.

A.C. is happy with his comfort and vision, and the cornea remains healthy. He is scheduled for suture removal and implantation of an intraocular lens this month.

For this photograph, we used the anterior segment setting on the Topcon retinal camera. CLS

Special thanks to Dick Nelson of PC Optical Products and the staff of Four Seasons Eyecare, including Anita Burke, Tami Woolridge and Angie Simon, optometric technicians.

Dr. Verkuilen is in group practice in Plymouth, Minn.