July 2015 Online Photo Diagnosis

By Gregory W. DeNaeyer, OD, FAAO

This image shows superficial punctate keratitis (SPK) in a 58-year-old patient who has ocular graft-versus-host disease (oGVHD). The patient complained of severe dryness and stated that “drops don’t last long.” At his initial visit, the patient was using GenTeal (Alcon) gel q.h., Restasis (Allergan) b.i.d., Pred Forte (Allergan) b.i.d., and Systane (Alcon) p.r.n.

His uncorrected visual acuity was OD 20/25 and OS 20/60. Besides severe SPK of both eyes, slit lamp exam showed moderate blepharitis and mild-to-moderate conjunctival injection. We fit the patient into 18mm scleral lenses. At the dispensing visit, his vision improved to 20/20 in both eyes after application of the scleral lenses.

We prescribed Clear Care (Alcon) for lens cleaning and disinfection and a 0.9% sodium chloride inhalation solution to fill the lens prior to application (off label).

At a follow-up appointment, the patient reported doing well, with significantly improved comfort. The right lens was eventually loosened to adjust the fit.