April 2013 Online Photo Diagnosis

By Gregory W. DeNaeyer, OD, FAAO

Figure 1 shows the right cornea of a 53-year-old keratoconus patient who developed epitheliopathy of her right cornea secondary to scleral lens wear. The patient's BCVA with refraction was 20/80 OD at the initial visit, and she was not wearing contact lenses. Her right eye has been fit with an 18mm scleral contact lens (Figure 2).

The patient's cornea was clear before wearing the scleral lens (Figure 3), but later developed epithelial irregularity.

Although not common, epitheliopathy is a potential complication of scleral lens wear. It most often occurs in patients who have undergone a penetrating keratoplasty, but it also can develop in patients who have keratoconus. The epitheliopathy does not seem related to a poor fitting relationship between the scleral lens and the anterior ocular surface. It is unknown whether this complication resolves after discontinuing use of the scleral lens. Generally, patients who exhibit scleral lens-induced epitheliopathy are asymptomatic and maintain good vision with their scleral lens.