This photo shows the right eye of a 60-year-old male who complained of poor vision and dryness of both eyes. The patient was referred for specialty lens evaluation with a diagnosis of dry eye syndrome and recent failure using Restasis (cyclosporine ophthalmic emulsion) 0.05% (Allergan) and Xiidra (lifitegrast ophthalmic solution) 5% (Shire). Current therapy for dry eye management was Muro 128 (sodium chloride hypertonicity ophthalmic ointment, 5%, Bausch + Lomb). He has a history of undergoing cataract surgery in both eyes and has mild amblyopia OS.

A slit lamp exam revealed punctate keratitis and reduced tear breakup time OD and OS. The patient also had moderate epithelial basement dystrophy. Corneal topography showed moderate surface irregularity. Manifest refraction was OD +0.25 –1.50 x 162, 20/40 and OS plano –0.75 x 030. He is pseudophakic with clear and centered intraocular lenses.

It was mutually decided to fit the patient with scleral lenses. Corneo-scleral topography measured oblique scleral toricity. Scleral lenses with a diameter of 16mm and back-surface-haptic toricity were designed. The lenses were manufactured using Hexa 100 (Contamac) with HydraPEG (Tangible Science) to maximize wettability. The patient achieved visual acuity of OD 20/20 and OS 20/50. Months of wear will determine the success of his dry eye management.

For this case, scleral lenses offer the unique ability to manage his dry eye as well as corneal irregularity secondary to punctate erosions and corneal dystrophy.