Contact Lens Case Reports

Scleral Lenses Benefit in a Case of Extreme Dry Eye

By Patrick J. Caroline, FAAO, & Mark P. Andre, FAAO

Our patient was a 42-year-old female who had failed with a number of reusable soft contact lenses and hydrogen peroxide disinfection as well as with daily disposable lenses. Her maximum wearing time was four hours, after which dry eye symptoms dictated lens removal.

The patient underwent bilateral photorefractive keratectomy (PRK) in 2007 with an excellent surgical outcome of 20/20 uncorrected visual acuity in both eyes (Figure 1). Shortly after the surgery, the patient began to experience extreme dry eye symptoms. Her symptoms have persisted since 2007 despite maximum dry eye treatment. Her only relief was found in wearing plano-powered moist chamber goggle spectacle lenses.

Figure 1. Patient's corneal topographies post PRK.

Sclerals Bring Dry Eye Relief

The patient appeared in our clinic having heard about the possible benefits of wearing scleral contact lenses for her chronic dry eye condition. She was subsequently fitted with scleral lenses that immediately relieved her dry eye symptoms and that today she wears for 14 to 16 hours a day with 20/20 vision.

At her one-year follow-up visit, we noted that she had developed a small, asymptomatic, inferior conjunctival prolapse on the right eye only. We believe this to be a benign condition that occasionally occurs beneath scleral lenses that completely vault the cornea and limbus and come to rest on the sclera (more specifically the bulbar conjunctiva). We suspect that fluid forces (similar to those that occur in orthokeratology) draw the conjunctival tissue up beneath the lens at the limbus. This prolapse can be seen with both the slit lamp (Figure 2) and with anterior segment optical coherence tomography (OCT) (Figures 3 and 4). As we discussed in our April 2012 column, despite its somewhat disconcerting look, the prolapse appears to carry with it no apparent long-term ramifications.

Figure 2. Patient's right eye following one year of scleral lens wear.

Figure 3. OCT image of the right eye. Note the conjunctival prolapse at the edge of the scleral lens.

Figure 4. OCT image of the left eye.

This case highlights the dramatic improvement that some patients experience when switching from maximum medical dry eye treatment to simple scleral contact lenses. CLS