A 50-year-old female presented for a consultation for possible contact lens fitting. She had a history of radial keratotomy (RK) 20 years prior and had 15 years of good vision. Over the last five years, she reported decreasing vision. And over the last 12 months, she reported feeling unsafe driving and had taken a leave from her job as a nurse until she could improve her vision and become functional again. Best-spectacle-corrected vision was 20/60 in each eye. The slit lamp examination in the left eye looked similar to the right eye, pictured above.

The patient in the photo has corneal ectasia post radial and astigmatic keratotomy in both eyes. The area of ectasia is nestled between two radial cuts and an astigmatic cut. The area of staining correlates to the ectatic area, and the staining is comparable to swirl staining seen with keratoconus and GP lens wear, though this patient had not worn contact lenses. The swirl staining is likely a result of lid wiper pressure during normal blinking eroding the epithelium.

The patient was fitted in scleral lenses that fully vaulted the corneal surface. With the lenses, her visual acuity was 20/25 in each eye, 20/20 OU. The corneal surface and epithelial health improved with the lens wear, as the lens and the fluid reservoir protected the corneal surface from the focal rubbing by the lid wiper. She was able to return to driving and her job.