Online Photo Diagnosis

By William Townsend, OD, FAAO

These photos show the anterior segment of a 19-year-old male who presented with discomfort and reduced vision. He admitted very poor compliance with his two-week daily wear lenses, wearing them on an extended basis and not removing them for months at a time.

The superior limbus shows edematous changes with and loss of normal peripheral corneal architecture. Palisades of Vogt are no longer visible, and neovascularization extends into the peripheral cornea.

These changes are now thought to be caused by damage to or loss of limbal stem cells secondary to chronic hypoxia and inflammation. This case gives contact lens practitioners yet another reason to closely monitor and advise patients regarding improper use of daily wear lenses on an extended wear basis.

For additional information, consider the following materials:

Martin R. Corneal conjunctivalisation in long-standing contact lens wearers. Clin Exp Optom 2007; 90: 1: 26�30

Lavker RM, Tseng SC, Sun TT. Corneal epithelial stem cells at the limbus: looking at some old problems from a new angle. Experimental Eye Research 78 (2004) 433–446