A 44-year-old female presented for a contact lens follow-up appointment. She had no new complaints and was just in for her scheduled progress check. Her visual acuity in her right eye was hand motion and 20/25 in the left eye. Below is the slit lamp image of the left eye (Figure 1).

The patient has Salzmann’s Nodular Degeneration (SND) and uses a piggybacked GP over a bandage soft lens. Her right eye had had a penetrating keratoplasty and developed a fungal infection, which led to graft failure and opacification of the cornea resulting in no functional vision.

The left eye, which had used an extended wear bandage soft lens only for several years for symptomatic relief, was fitted a year prior to this appointment in GP over the bandage soft lens improving VA from 20/200 to 20/25 (Figure 2). The patient was able to wear her bandage soft lens on a 30-day extended wear basis with the GP over the soft lens on a daily wear basis.

SND is a secondary, non-involutional corneal degeneration, typically associated with chronic trauma or inflammation. It results in small bluish white bumps on the corneal surface. Though it is more common to find the in the midperiphery or periphery of the cornea, they can also occur in the visual axis.

Symptoms of SND often include a foreign body sensation or chronic irritation and mild redness. If nodules become large enough or central enough, vision reduction can occur. Nodules can be removed; though, without removal or treatment of the underlying cause, they will often return, and patients may be symptomatic even prior to the nodule returning. Treatment involves trying to manage the underlying cause and to manage the related symptoms.

Treating lid disease, steroids when tolerated, doxycycline, and contact lenses can all be used to manage the symptoms. Bandage soft lenses can be used to provide symptomatic relief in some situations. Scleral lenses are also a current, frequently used option, as they correct the vision with GP optics and keep the corneal protected with the tear reservoir.

In this case, the patient was comfortably tolerating bandage soft lens wear and adding a piggybacked GP was a simple, well-tolerated management strategy. The bandage soft lens protected the corneal surface from breakdown to due GP lens friction, and the patient had functional vision in this eye.