July 2013 Online Photo Diagnosis

By Gregory W. DeNaeyer, OD, FAAO

Pictured is the left eye of a 78-year-old female patient who developed severe dry eye after undergoing recent uneventful cataract surgery. She was diagnosed with macular degeneration in 2009. Systemically, the patient is managed for hypertension, congestive heart failure, chronic obstructive pulmonary disease, non-rheumatoid arthritis, and depression. She currently resides in a care facility.

The patient's visual acuity is OD 20/30 and OS 20/200. Her left cornea has moderate superficial keratitis and irregular epithelium. Her right cornea is clear. The patient uses Refresh (preserved) artificial tears (Allergan) two to three times a day. The patient had previously failed with Restasis (Allergan) and Lotemax (Bausch + Lomb). A punctal plug was inserted into her left lower puncta, but it did not significantly improve her signs or symptoms. She was fit with standard bandage soft contact lenses, but they did not remain on the eye during extended wear. The patient was referred to our clinic for specialty lens evaluation.

Scleral lenses were ruled out as an option because it was unlikely that the patient would be able to apply or remove them. She was fit with a 20mm-diameter bandage hydrogel contact lens with a base curve of 9.2mm for continuous wear, with the goal of providing her with uninterrupted surface protection. The large diameter size was chosen to decrease the risk of spontaneous lens ejection. Unfortunately, the patient's eye became red and irritated with the large bandage soft lens, which forced her to discontinue wear.

The patient is currently being managed by her local eyecare providers as other options are explored.