October 2016 Online Photo Diagnosis

Gregory W. DeNaeyer, OD, FAAO

This image shows conjunctival prolapse with an intralimbal GP lens. The patient is a 55-year-old female who has severe keratoconus. The patient had previously failed in scleral and hybrid contact lenses, but she has successfully worn this intralimbal lens for the past eight years. The lens has a diameter of 11.5mm and base curve of 7.11mm. Her visual acuity is 20/20, and she reports the lens to be comfortable, despite significant inferior edge lift. She uses a hydrogen peroxide care system for cleaning and disinfection because she had developed a previous hypersensitivity to a multipurpose cleaning and disinfection system.

Conjunctival prolapse is typically observed in scleral GP lenses when loose bulbar conjunctiva is found within the space between the scleral lens and cornea that holds the liquid reservoir (Figure 2). It is unusual to observe this in a patient wearing a corneal GP design. Conjunctival prolapse is thought to be a benign complication. It is possible that the bulbar conjunctiva could adhere to the cornea or cause mild secondary neovascularization (Chen, 2016; Caroline and André, 2013).

For this patient, no change is recommended at this time because she is subjectively happy with her current lens, and there are no secondary complications resulting from the prolapsed bulbar conjunctiva.

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