Ocular trauma can often result in the need for specialty contact lenses. Typically, this involves the use of corneal GP lenses or scleral lenses to improve visual acuity for patients who have corneal irregularity as a result of their injury. Another less common injury is blunt trauma that doesn’t affect the cornea but instead causes damage to the sphincter muscle of the iris, resulting in temporary or permanent pupillary dilation. Cosmetically, this can be a concern, especially if patients have a lighter-colored iris. Optically, traumatic mydriasis increases higher-order aberrations, especially spherical aberrations (Wang et al, 2003), which can result in reduced vision. Patients also commonly complain of significant photophobia and glare.

Case Example

A 50-year-old male was referred by his ophthalmologist for a specialty contact lens evaluation after suffering a traumatic injury to his left eye in which he was struck with a bungee cord six months before. His history was significant for having laser-assisted in situ keratomileusis (LASIK) surgery 15 years prior to his injury. He complained of reduced vision, glare, and photophobia. His uncorrected visual acuity measured 20/30 OD and OS. Manifest refraction was OD +0.25 –1.50 x 055, 20/20 and OS +0.75 –0.50 x 104, 20/20. Ocular examination revealed a dilated pupil OS that was non-reactive (Figure 1).

After discussion, we decided to fit the patient with a prosthetic soft contact lens for his left eye to reduce his effective pupillary aperture. Photos were taken of his right iris for reference. His horizontal visible iris diameter measured 11.5mm, and right photopic pupil was 4.5mm. We opted to fit a computer-fabricated prosthetic soft lens design. The manufacturer sent a trial diagnostic lens with an 8.6mm base curve, 14.5mm diameter. The diagnostic lens was ideally centered and was comfortable for the patient. A color guide was used to determine the best match for his right eye from the available iris designs. A prosthetic lens was ordered with a +0.50D spherical equivalent power. Importantly, a black backing was specified to completely block light peripherally.

At dispense, the patient was satisfied with the cosmetic appearance (Figure 2) and comfort, and vision measured 20/25. At follow up, he reported significantly less glare with the prosthetic lens.

In Conclusion

Patients who have traumatic mydriasis can have cosmetic and visual concerns that affect their daily lives. Surgical corrections such a pupilloplasty or iris implants carry significant risk and are not usually a primary treatment. This patient was successful with a prosthetic soft contact lens. CLS

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