Scleral Lens Anterior Surface Localized Mucin Deposits

A 25-year-old female patient has bilateral keratoconus and has worn scleral lenses since 2014. She always had a tendency to form deposits on her lenses. She reported blurry vision after every four to six months of wear. Slit lamp examination always showed normal biomicroscopy.

Every six months, we had to clean and polish her lenses; this became more frequent after she started to work eight hours a day in front of a computer screen and use her smartphone for additional hours. She cleans her lenses with multipurpose lens solution with and vigorous rubbing, and this led to scratches on the lens surface (Figures 2, 3, and 4).

The Fitting

The fitting process remained successful (Figures 5 and 6) with a visual acuity (VA) OU of 20/20^-1 with corneal physiological health. Specular microscopy performed in 2022 presented with a cell density of 2,424 OD and 2,451 OS.¹

Discussion

The deposits on her lenses may be a combination of a heavy deposit in her tear film combined with the very low blink rate.² Slit lamp observation showed that the tear meniscus height was higher than 0.5mm³ at the same area over the localized deposits (Figure 7).

The patient was instructed to pay attention to her blink rate, because blinking is crucial to distribute the tear layer over the cornea. With the scleral lens on the eye, a sensation of dryness is less perceived. This combination of factors may have led to the formation of the localized mucin deposits.

Conclusion

After the patient was informed about her situation and instructed to pay attention to her blink rate and make some breaks during computer and smartphone use, the proposed treatment proved to be effective.

References

1. Bonnell A, Cymbor M. Under the Specular Microscope. Rev Optom. 2012 Aug 15. Available at reviewofoptometry.com/article/under-the-specular-microscope . Accessed March 13, 2023.
2. Abelson MB, ORA Staff. It’s Time to Think About the Blink. Rev Ophthalmol. 2011 June 13. Available at reviewofophthalmology.com/article/its-time-to-think-about-the-blink . Accessed Feb. 15, 2023.
3. Patel AS, Bustos DE, Masters JS, et al. Dry Eye Syndrome. EyeWiki. 2022 Oct 10. Available at eyewiki.aao.org/Dry_Eye_Syndrome . Accessed Feb. 15, 2023.

Mr. Bastos is the director and clinical instructor of specialty contact lenses at the Instituto de Olhos Dr. Saul Bastos (IOSB), and is the director and specialty lens consultant of Ultralentes, a small laboratory specializing in GP and scleral lens designs in Porto Alegre, RS, Brazil.