PEDIATRIC AND TEEN CL CARE

GP LENSES FOR OCULAR TRAUMA IN CHILDREN

MELANIE FROGOZO, OD, FAAO

Ocular trauma is a common cause of monocular visual disability in children. Refractive complications resulting from ocular trauma include irregular astigmatism and surgical aphakia, both of which are well corrected by GP optics (Pradhan et al, 2014). This article will review treatment of ocular trauma using GP contact lenses.

Irregular Astigmatism

Irregular astigmatism is not correctable with standard glasses or soft contact lenses. In such cases, GP lenses are needed to mask the irregularity and to create more focused optics to restore vision (Sindt, 2006). Corneal scarring creates a challenge to fitting these lenses due to the increase in elevation above the scar and the drastic depression adjacent to it.

This change in elevation may vary, depending on the depth of the scar and the manner in which it healed. These irregularities in elevation may cause difficulties centering a lens and may trap application bubbles in the areas of depression. Using a large-diameter corneal GP or scleral contact lens will help with centration and provide enough depth to fit over the scar (Alipur and Hosseini, 2016).

Aphakia

Unilateral aphakia often results from surgical removal of a traumatic cataract after a penetrating ocular injury. This may be managed with an intraocular lens implantation. However, the necessary surgeries are often very complex due to damage to the capsular bag. Therefore, a contact lens offers a more practical, less invasive, and less expensive alternative to visual rehabilitation. (Pradhan et al, 2014; Sindt, 2006).

Although soft lenses are offered in high plus powers to correct for aphakia, a rigid lens is needed to correct for any irregular astigmatism from a penetrating corneal scar. In aphakic patients, all astigmatism remains within the cornea. Thus, GP optics simplify correction (Pradhan et al, 2014).

Trauma Case Management with a GP Lens

A 5-year-old boy presented to our office with a history of corneal scarring and aphakia due to a penetrating injury to his left eye from a tree branch. A traumatic cataract resulted. However, due to insufficient capsular support, he was left aphakic.

A corneal GP lens was difficult to fit directly onto his cornea due to the large area of uneven and elevated scar tissue. Therefore, the patient was fitted into a scleral contact lens for treatment (Figure 1).

Figure 1. A 5-year-old boy fitted into a scleral contact lens for correction of irregular astigmatism and aphakia caused from trauma.

Summary

Ocular trauma in children often results in decreased vision from irregular astigmatism and aphakia. In cases such as these, GP lenses provide the optics necessary to rehabilitate vision. GP contact lenses can offer a practical, less invasive, and less expensive alternative to surgery in cases of ocular trauma. CLS

To obtain references for this article, please visit www.clspectrum.com/references and click on document #251.

Dr. Frogozo specializes in adult and pediatric specialty contact lenses. She is the director of the Contact Lens Institute of San Antonio and the owner of Alamo Eye Care in San Antonio, Texas. She also is a consultant to CooperVision. You can contact her at contactlensinstitutesa@gmail.com.