contact lens case reports

When the Eye Needs A Bandage

By Patrick J. Caroline, FCLSA and Mark P. Andre, FCLSA, FAAO
December 2001

Figure 1. Thygeson lesions on the patient's right eye.

Patient SR is a 22-year-old female referred to our contact lens clinic with a primary diagnosis of Thygeson's Superficial Keratitis (TSK) (Figure 1). TSK is a rare, bilateral, punctate keratitis of unknown etiology that often presents in individuals under the age of 40. The epithelial lesions are gray, irregularly shaped and slightly elevated. There is no stromal involvement or anterior chamber reaction. The patient's subjective symptoms often include a marked foreign body sensation, tearing and photophobia. The condition runs a chronic course with frequent episodes of exacerbation and remission.

Therapy

Currently, there is no specific treatment for the condition; however, dramatic improvement often occurs with topical steroids (0.1 percent betamethasone or 0.5 percent prednisolone five times a day for five days) and/or bandage contact lenses worn on a daily- or extended-wear basis. The exact mechanism responsible for the improvement with bandage lenses is unknown.

Bandage Lenses

The major objectives for the use of bandage contact lenses are pain management, mechanical protection and maintenance of surface hydration.

Pain is managed by providing a bandage over epithelial defects and exposed nerve endings. Additionally, therapeutic lenses provide a mechanical barrier between the lid and the corneal surface that helps to promote wound healing from newly-formed cells. Other positive features of some therapeutic lenses include their use as a vehicle for drug delivery, maintenance of corneal hydration and, in some situations, vision enhancement.

Table 1 lists some of the current therapeutic lens options available for the treatment of a wide range of anterior segment diseases or surface anomalies.

Figure 2. Silicone hydrogel lens on the patient's right eye.

It should be mentioned that neither of the silicone hydrogel lenses currently have a specific bandage lens indication. Therefore, any use of these products for therapeutic purposes must be considered off-label use.

In our case, we fitted the patient with PureVision lenses on a 30-day continuous wear schedule (Figure 2). Within days of initiating the bandage lenses, the patient noted significant improve- ment in her symptoms and in visual acuity. Her steroid therapy was tapered and eventually discontinued. Today, her condition remains stable with only the bandage lens therapy.

Patrick Caroline is an associate professor of optometry at Pacific University and an assistant professor of ophthalmology at the Oregon Health Sciences University.

Mark André is director of contact lens services at the Oregon Health Sciences University.