Colored contact lenses have an important role as prosthetics for diseased and traumatized eyes. Prosthetic lenses improve the cosmetic appearance of children who have ocular disfigurement or asymmetry. Additionally, these lenses provide relief for patients who have visual discomfort such as photosensitivity (Truong et al, 2014). Children benefit from wearing prosthetic contact lenses for a variety of medical and reconstructive cosmetic reasons; this article presents a few of those reasons.

Achromatopsia and Albinism Children who have achromatopsia have abnormal or absent cone function that causes severe photophobia. Although tinted glasses help relieve symptoms of photophobia, wearing them may not always be cosmetically acceptable. Similar to tinted spectacles, tinted contact lenses limit photosensitivity by decreasing light exposure. Therefore, an alternative to spectacles is a darkly tinted translucent prosthetic contact lens.

Children who have albinism lack ocular pigment and have iris transillumination defects. As such, these patients are very light sensitive and benefit from iris-occluding prosthetic lenses that include an opaque underprint that blocks peripheral light transmission. This type of lens effectively reduces light sensitivity due to albinism, with good cosmesis.

Colobomas and Microcornea Iris colobomas can be cosmetically masked using a prosthetic contact lens with an iris overlay. These iris-occluding lenses can either be computer-generated or hand-painted. Patients who have colobomas are often photosensitive and benefit from an opaque backing on the posterior surface of the lens to help block extraneous light.

Children who have unilateral microcornea have noticeably different visible iris diameters. Masking the microcornea with a prosthetic contact lens gives a more symmetrical appearance between the eyes. This is accomplished using a prosthetic lens with a colored limbal ring that increases the appearance of the overall size of the cornea.

Trauma Ocular trauma is a leading cause of non-congenital unilateral vision loss in children (Abbott and Shah, 2013). Complications resulting from ocular trauma include traumatic aniridia and corneal scarring. In such cases, an iris-occluding or translucent colored prosthetic lens can restore good cosmetic appearance with the unaffected eye. In situations in which the trauma also results in irregular astigmatism or high refractive error, a prosthetic soft colored lens can be used in a piggyback system in combination with a GP lens to restore both vision and cosmesis.

A Case in Point

A 15-year-old Hispanic female who had Peters anomaly provides an example of masking corneal irregularities with a translucent tinted lens. This patient was born with microcornea and a central corneal scar (Figure 1A). A translucent brown tinted lens with a colored iris diameter that matched her sound eye effectively masked her corneal scar and visible iris asymmetry (Figure 1B).

Summary

There are a variety of indications for the use of prosthetic colored contact lenses in children. While they have medical benefits, the cosmetic improvements are equally important, if not more so, to the patients. Whenever possible, consider the use of these lenses for pediatric patients. CLS