Because of their unique characteristics, large-diameter contact lenses have gained popularity of late. The large surface area of these lenses better distributes the lens weight across the ocular surface. This decreases friction between the lens and the corneal surface, improving comfort. Because they are fluid-filled, scleral lenses also provide continuous lubrication to the eye, aiding the treatment of ocular surface disease, and they improve vision in cases in which refractive rehabilitation is needed.

A Road Less Traveled

Another use for these large-diameter lenses is for improving lid cosmesis in cases of blepharoptosis of the upper eyelid. This condition can result from a variety of disease processes including Horner’s syndrome, myasthenia gravis, and traumatic levator dehiscence, among others. Traditional management of blepharoptosis includes surgical blepharoplasty; however, such procedures may result in lingering concerns. For example, blepharoplasty may impair the ability of the lids to close completely, leaving patients at risk for severe corneal dryness and exposure keratitis.

Large-diameter scleral lenses are a possible non-surgical alternative to improve cosmetic appearance in cases of blepharoptosis (Shah-Desai et al, 2011; Katsoulos et al, 2018). The increased size of scleral lenses creates a bulky mass that is able to elevate the upper eyelid in such cases.

A Case in Point

Consider a 17-year-old Hispanic male who had a history of traumatic levator dehiscence of the right eyelid. This patient underwent blepharoplasty surgery at the age of 13 years, with no improvement in cosmetic appearance (Figure 1A).

A large-diameter 19mm scleral contact lens fitted on the right eye provided the patient with satisfactory improvement in the appearance of his ptosis (Figure 1B). Additionally, his vision was improved by correcting the corneal astigmatism present in that same eye.

Summary

Scleral lenses can provide cosmetic eyelid elevation and visual rehabilitation. Thus, scleral lenses are an alternative treatment modality for patients who would otherwise have to opt for ptosis surgery, with guarded prognosis.

This case presented the successful cosmetic and rehabilitative use of scleral contact lenses for the management of difficult blepharoptosis. Large-diameter contact lenses are useful when treating ptosis in cases in which surgery could result in a suboptimal outcome. CLS

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