contact lens case reports

Stevens-Johnson Patient Benefits from Scleral Lens Wear

BY PATRICK J. CAROLINE, FAAO, & MARK P. ANDRÉ, FAAO

Pathologic dry eye encompasses a wide range of disorders that include such conditions as ocular pemphigoid, Stevens-Johnson syndrome, Sjögren's syndrome, and chemical burns. Stevens-Johnson syndrome (SJS) is a rare condition that occurs most commonly in children or in young to middle-aged adults. The etiology of SJS can be multifactorial. However, the condition is often the result of exposure to any of a variety of systemic or topical drugs.

The onset of SJS is usually sudden and stormy with fever, malaise, sore throat, and respiratory symptoms. This is followed by the appearance of skin lesions on the hands, feet, arms, legs, trunk, and face. The mucous membranes, especially of the eyes, mouth, and genitalia, may be particularly affected by the erosive lesions.

At the onset of the disease, the ocular course is difficult to predict. However, not infrequently, the most serious long-term sequelae are the ocular complications.

A Scleral Lens Fit

A 25-year-old male was diagnosed with SJS at age 3. Today, the patient continues to exhibit the chronic ocular manifestations of SJS that include severe keratoconjunctivitis sicca, conjunctival and corneal scarring, keratinization of all ocular membranes and lid margins, corneal vascularization, entropion, trichiasis, and symblepharon (Figure 1). The patient's best corrected visual acuity was 20/100 in both eyes.

The patient's ocular therapy has included lid hygiene b.i.d., frequent (hourly) non-preserved artificial tears, nightly preservative-free ointment, and frequent lash epilation. However, due to ongoing complications associated with the lids and lashes, it was determined that he might benefit from high-Dk scleral lenses.

Figure 1. The patient's severe surface disease associated with SJS.

We subsequently fit the patient with Jupiter scleral lenses (Medlens Innovations, Inc./Essilor, Figure 2) in the following parameters: OD 6.75mm base curve, 15.6mm diameter, −18.00D power and OS 7.35mm base curve, 15.6mm diameter, −17.50D power. His visual acuities improved to 20/40 OU.

Figure 2. 15.6mm Jupiter scleral lenses.

A Number of Benefits

High-Dk scleral contact lenses provide a number of benefits to patients who have severe ocular surface disease including improved visual correction; protection of the ocular surface from scarred lid margins, entropion and trichiasis; ongoing lysis of symblepharon to maintain the conjunctival fornices; and protection of the ocular surface from the debilitating effects of tear evaporation.

Clinical experience has shown that initially these patients may benefit from removing their lenses every four-to-six hour to remove trapped debris from beneath the lenses. The bowl of the lens can then be replenished with a preservative-free solution prior to application. CLS

Patrick Caroline is an associate professor of optometry at Pacific University. He is also a consultant to Paragon Vision Sciences. Mark André is an associate professor of optometry at Pacific University. He is also a consultant for CooperVision.