Fitting a therapeutic scleral lens on a regular cornea of a patient who has Stevens-Johnson syndrome (SJS) complicated by suspected corneal edema presents unique challenges.
HISTORY
A patient who previously underwent laser in situ keratomileusis (LASIK) in 2009 developed SJS in 2023 after starting allopurinol.1,2 Initial symptoms included keratoconjunctivitis, and rapidly progressed to rashes on the face and upper body. After recovering from the acute symptoms, the patient continued to experience keratoconjunctivitis, using preservative-free artificial tears and considering alternative treatments due to the high cost of autologous serum.
The patient was fitted with a 16.0mm scleral lens in the more affected right eye, but experienced a rainbow and cloudy vision, with observed haptic compression and impingement. Specular microscopy showed normal cell counts, although the right eye displayed slight polymegathism and pleomorphism.
CONTACT LENS FITTING
The patient was refitted with a new 16.5mm scleral lens design, which showed a smooth landing. The patient reported comfort and good visual acuity with the initial lens, but after five to six hours of wear, experienced the same symptoms, though less severe. Slit lamp examination revealed no corneal edema, likely indicating epithelial edema.
To address this, oxygen delivery was increased to the cornea using two designs: one with a triple fenestration in a triangle pattern, and another with non-visible ventilating channels in the haptic. Both lenses were dispensed for the patient to evaluate.
Base curve – 43.00D (7.85mm), power – +0.50D, diameter – 16.8mm, sagittal height – 5.081, Dk of 200.
OUTCOME
The patient reported that the ventilating channels lens provided better performance, allowing up to seven to eight hours of wear before symptoms appeared—an improvement over his original scleral lens fit elsewhere.
CONCLUSION
Fitting scleral lenses for SJS patients requires creative solutions, even when using high-Dk materials. Individualized strategies, such as improving oxygenation, can significantly enhance patient outcomes.
REFERENCES
- National Library of Medicine. Allopurinol. MedlinePlus. 2023 Sep 15. Available at medlineplus.gov/druginfo/meds/a682673.html. Accessed 2024 Sep 19.
- VanWert AL. Allopurinol – Uses, Side Effects, and More. WebMD. 2024 Jun 13. Available at webmd.com/drugs/2/drug-8610/allopurinol-oral/details. Accessed 2024 Sep 25.
