readers' forum

RGP Scleral Lenses for Terrien's Marginal Dystrophy

DONALD F. EZEKIEL, AM, DIP OPTOM
& DAMON J. EZEKIEL, B OPTOM
JANUARY 1998

There are certain conditions where the only option for patients to obtain ocular comfort or achieve optimum visual acuity is with a scleral contact lens. And with the advent of gas permeable scleral lenses, more patients are benefitting from greater fitting ease and higher oxygen permeability than PMMA lenses can provide. Terrien's marginal dystrophy is one condition where a scleral lens resulted in comfort and visual acuity not possible with any other lens or optical aid. A non-inflammatory thinning of the marginal cornea, the condition occurs bilaterally and predominantly affects males. Although it is considered uncommon, we treated two patients with the condition within the past 12 months.

Seeking Good Comfort & Vision

This patient is a 28-year-old woman with signs of early marginal degeneration in her right eye (Fig. 1). Her left eye has Terrien's marginal dystrophy, with large lipid deposits over a large portion of the cornea (Figs. 2 & 3). There is only a 5.0mm by 3.0mm area of clear cornea occupying the temporal half of the pupil zone. Surrounding this, the corneal stroma is extremely thin, perhaps only 20 percent of normal thickness, with an overlying conjunctival vascular cover and lipid deposits. The patient reported that the eye was constantly irritated and uncomfortable. Her visual acuity was a blurred 40/200. Previous attempts to fit her with corneal lenses were not successful due to the extreme distortion of the cornea.

Success with Sclerals

We fitted the patient with a gas permeable scleral contact lens according to the protocol described in the July 1991 Contact Lens Spectrum article, "Gas Permeable Scleral Lenses" (Fig. 4). Her comfort was immediate and continued with all day wear. Visual acuity also improved to 20/20.

Photographic records of her cornea taken over the course of several years documented progression of the lipid opacification across the cornea. With the comfort and protective effect of the gas permeable scleral lens, it will be interesting to see if the opacification creep that had occurred over the years will continue to progress.

While fitting this patient with a gas permeable scleral lens was straightforward and uneventful, the results were dramatic and could not be achieved with any other type of contact lens or ocular aid.

FIG 1:  Terrien's Marginal Dystrophy	FIG 2:  Terrien's Marginal Dystrophy (Advanced)
FIG 3: Terrien's Marginal Dystrophy (Advanced)	FIG 4:  Terrien's Marginal Dystrophy (Advanced)

To receive references via fax, call (800) 239-4684 and request document #32.

Dr. Donald Ezekiel is the CEO of Gelflex Laboratories and Dr. Damon Ezekiel is the director. Both are in a specialty contact lens practice in West Perth, Western Australia.