Pingueculae are yellow raised areas of the interpalpebral nasal or temporal conjunctiva. Commonly found in individuals of middle age, pingueculae are the result of a degeneration process secondary to chronic sun exposure (Jain, 2013).

Soft lenses do not increase the risk of pingueculae, but rigid lenses appear to be a risk factor (Dundar and Kocasarac, 2019; Mimura et al, 2010; DeNaeyer and Sanders, 2020). Pingueculitis results from acute inflammation that leads to conjunctival redness and irritation. Scleral lenses can lead to pingueculitis secondary to impingement of the landing zone. A retrospective study of scleral lens complications of a keratoconus population found pingueculitis to be an adverse event for 1.3% of patients (Fuller and Yang, 2020).

Cases

A 15-year-old patient who has high astigmatism complained of poor visual acuity (VA) OD with soft contact lens wear. Manifest refraction OD was +4.00 –4.75 x 010 20/25. After ruling out keratoconus, the patient’s eye was successfully fit with a 16mm free-form scleral lens designed from profilometry measurements.

Sixteen months later, he reported redness and irritation with scleral lens wear. Examination revealed nasal pingueculitis secondary to scleral lens impingement (Figure 1). The patient was asked to return to remap his right eye after scleral lens discontinuation. A 16.5mm free-form lens was designed from measurements that included a nasal localized vault and dispensed to the patient. At follow-up, the newly fit lens vaulted the pinguecula (Figure 2) and eliminated his pingueculitis.

A 54-year-old male reported increasing temporal redness of his left eye with scleral lens wear. Examination revealed temporal pingueculitis secondary to scleral lens impingement. Previous to wearing scleral lenses, his left eye had a history of laser-assisted in situ keratomileusis (LASIK), retinal detachment, cataract surgery, and corneal scarring.

Irregular astigmatism resulted in decreased VA and complaints of ghosting. He had successfully been wearing a standard 16.5mm scleral with a spherical landing zone for the previous four years that improved his vision. The patient was asked to return for corneoscleral topography measurements after discontinuing scleral lens wear. A 16.5mm free-form scleral lens was manufactured that included a temporal localized vault to prevent impingement. After one adjustment of the landing zone to eliminate movement, the final lens (Figure 3) provided a fit that no longer impinged the pinguecula, resolving his pingueculitis.

Conclusion

Pingueculitis can result after months or years of successful scleral lens wear secondary to pinguecula formation or growth. Refitting the patient with lenses that include a localized vault will eliminate impingement and resolve inflammation. CLS

References

1. Jain D. Pinguecula. PathologyOutlines.com . 2013 Feb 1. pathologyoutlines.com/topic/eyepinguecula.html . Accessed July 2, 2022.
2. Dundar H, Kocasarac C. Relationship Between Contact Lens and Pinguecula. Eye Contact Lens. 2019 Nov;45:390-393.
3. Mimura T, Usui T, Mori M, et al. Pinguecula and contact lenses. Eye (Lond). 2010 Nov;24:1685-1691.
4. DeNaeyer GW, Sanders DR. Scleral mapping of a progressive pinguecula that required a customized scleral lens. Poster presented at the Global Specialty Lens Symposium, January 2020, Las Vegas.
5. Fuller DG, Wang Y. Safety and Efficacy of Scleral Lenses for Keratoconus. Optom Vis Sci. 2020 Sep;97:741-748.