A 30-year-old Caucasian male presented with issues with the scleral lens in his left eye. He has a history of longstanding Bell’s palsy due to an acoustic neuroma removal. He was originally fit in a scleral lens due to corneal exposure and reported that his vision was great for the first couple of hours but would slowly deteriorate and become uncomfortable. Removing, cleaning, and reapplying the lens helped, but it must be done several times during the day.

EXAM FINDINGS

Entering distance visual acuities were 20/25 OD uncorrected and 20/40 OS with correction (scleral lens). Examination showed severe lid retraction on his left side with lagophthalmos. Figure 1 shows his scleral lens on the eye and Figure 2 shows after removal. Otherwise, the scleral fit appeared appropriate. A new lens was ordered with a polyethylene glycol (PEG)-based polymer with hopes of improved patient comfort and fewer deposits (Figure 3).

DISCUSSION

Scleral lenses are often plasma treated before shipping to a practice. Plasma treatment removes the hydrophobic elements from the surface of the lens through electrostatic discharge.¹ This treatment does wear off over time and can be exacerbated by abrasive cleaners.¹

PEG-based coatings are thought to improve wettability in an attempt to enhance comfort.² However, this coating can only be applied during lens manufacturing. The coating is permanently bonded to the lenses and designed to last the life of the lens, but vigorous rubbing, storing the lens dry, or use of incompatible cleaners may negatively affect the coating. If the coating does become affected, there is a conditioning solution available that can be used monthly to help restore the coating (Tangible Science, 2024).

CONCLUSION

While surface coatings are not necessary on all lenses, it may be best to consider this coating as an option with patients who are heavy depositors, have incomplete blink, or non-wetting lenses. This patient’s symptoms were fully resolved using a surface coating and ensures new lenses are ordered with this coating.

REFERENCES

1. Barnett M, Toabe M. Chapter 13: Scleral Lens Handling. In Barnett M, Johns L, eds. Contemporary Scleral Lenses: Theory and Application. 1^st ed. Bentham Science Publishers; 2017:352.
2. Tangible Science. Tangible Hydra-PEG. 2024. Available at tangiblescience.com/products/tangible-hydra-peg. Accessed 2024 Mar 25.