A 38-year-old male patient who has bilateral keratoconus has been wearing specialty corneal GP designs since 2010, with the last refit in July 2021. He visited our office for follow-up in September 2023, complaining of discomfort OD. Figure 1 displays what appears to be an erosion at the corneal apex close to the highest point of the keratoconus anterior elevation (Figures 2 and 3).
Careful slit lamp observation demonstrates that the fluorescein pattern was acceptable centrally and what was suspected to be an erosion was moving with the lens during blinking. Upon removal and reapplication of the right lens, the evaluation showed that there was no erosion. The lens demonstrated a small amount of deposit accumulation that retained the fluorescein.
Following up on the patient’s complaint, some epithelial abrasions were noted peripherally at the superior cornea (Figure 4), seemingly caused by a poor lens periphery and edge design. The lens defects may have been occurring from inadvertently rubbing the lens on an abrasive surface or possibly excessive lens rubbing during cleaning.
The GP Refit
Upon reorder, a new lens demonstrated a much better fluorescein pattern (Figure 5), while tear exchange was optimal and comfort reestablished.
It is always important to evaluate GP fitting on-eye by observing both fluorescein pattern under cobalt blue filter and also with the lens removed.