In our contact lens toolbox, there are readily available approved therapeutic bandage contact lens options in the boxed-product modality. These include extended-wear soft lens options made out of various silicone hydrogel materials. Depending on the ocular surface, certain fitting characteristics may require clinicians to think outside of the box.

No-Brainer Applications

A bandage contact lens (BCL) is often placed on compromised corneas for the management of abrasions, post-corneal cross-linking, or post-refractive surgery. The superficial nature of the epithelial disruption in these cases allows for corneal healing in as early as 24 to 48 hours and a BCL can easily facilitate this type of recovery. Short-term use of a lens typically does not extend past one week.

Ideally, minimal lens movement of a well-centered BCL, in combination with corneal and topical medications for infection control, supports epithelial regeneration. Outside of the corneal irregularity, these eyes usually have regular limbal and scleral profiles and no customizations in lens fitting are necessary.

Managing Chronic Discomfort

For eyes that have undergone multiple keratoplasty procedures, a highly irregular corneal surface with variable elevation patterns across the entire cornea is common. Fitting an off-the-shelf BCL will not suffice. Combining the flat central keratometric readings with larger than average corneal diameters can yield inadequate lens fits that can add to discomfort with lens wear.

These eyes often suffer from chronic ocular surface pain and a constant “raw” feeling of the eye. In the open eye state during the day, every blink can be debilitating, even though there are no obvious signs of mechanical trauma to the corneal surface.

In Figure 1, this eye most recently underwent its seventh corneal surgery and the smile-like pattern in the lower mid-periphery of the cornea are remnants of epithelial bullae after only two hours of wearing a scleral lens for management of corneal pain. Instead, a custom lathe lens in efrofilcon A material, 15.2mm with an 8.6mm base curve, was beneficial to alleviate daytime ocular discomfort for this patient.

Managing Chronic Epithelial Dysfunction

In compromised corneas that have longstanding deficiency of the delicate limbal stem cells, recurrent corneal abrasion is difficult to manage. Especially with decreased corneal sensitivity.

In Figure 2, the left eye of a patient that has aniridia-associated keratopathy is shown with a fresh central epithelial defect. This patient also suffers from floppy eyelid syndrome and requires overnight protection to prevent reopening of his unstable epithelium upon awakening. A large-diameter soft lens in methafilcon A material is placed on eye in the office and removed monthly for this patient.

Cost becomes a factor with the need to purchase so many lenses and while a frequent replacement silicone hydrogel lens option would help lower costs, a poor fit with excessive lens movement further puts the eye at risk for recurrent abrasion.

A Case-by-Case Basis

There is no single fitting philosophy when it comes to fitting therapeutic soft contact lenses. Multiple factors need to be taken into consideration. If the ultimate goal is corneal pain alleviation and corneal protection, use your arsenal of custom soft lens options to provide the best option for your patient and manage accordingly. CLS