Scleral Lens-Induced Conjunctival Prolapse Post-Penetrating Keratoplasty
Overview
A 74-year-old post-penetrating keratoplasty patient developed conjunctival prolapse in the right eye after scleral lens wear. Excessive central and peripheral vaulting of the scleral lens contributed to the prolapse, which improved following lens redesign with reduced vault and optimized haptic alignment.
Background
Penetrating keratoplasty (PK) patients often require specialty contact lenses to manage corneal irregularities. Scleral lenses provide vaulting over the cornea but may induce complications such as conjunctival prolapse, especially in elderly patients with loose conjunctival tissue. Prolapse is thought to result from negative pressure forces beneath the lens, particularly when the tear reservoir is uneven. Proper scleral lens fitting, including vault and haptic alignment, is critical to avoid such complications.
Data Highlights
| Parameter | Initial Lens | Redesigned Lens |
|---|---|---|
| Base Curve (BC) | 50 D x 46 D (6.75 mm x 7.34 mm) | 49 D x 47 D (6.89 mm x 7.18 mm) |
| Power | –6.50 D | –6.00 D |
| Overall Diameter (OAD) | 16.5 mm | 16.5 mm |
| Optic Zones (OZs) | 11.5 mm / 13.9 mm | 12.0 mm / 13.5 mm |
| Sagittal Depth (SAG) | 6,258 μm | 6,005 μm |
| Dk (Oxygen Permeability) | 200 | 200 |
| Central Vault Reduction | N/A | 253 μm less than initial |
Key Findings
- Conjunctival prolapse occurred in the right eye after scleral lens wear in a post-PK patient.
- Excessive central and superior vaulting of the scleral lens contributed to prolapse development.
- Anterior tomography revealed a flat central graft area with a steep peripheral cornea, necessitating vaulting.
- Initial haptic design did not align well with the scleral shape, exacerbating prolapse.
- Redesigning the scleral lens with reduced central vault and modified haptic landing zone improved prolapse.
- Alternating between corneal GP and scleral lenses helped minimize symptoms during management.
Clinical Implications
Clinicians fitting scleral lenses post-penetrating keratoplasty should carefully assess corneal and scleral topography to optimize vault and haptic alignment. Excessive vault, especially superiorly, may induce conjunctival prolapse due to negative pressure forces under the lens. Adjusting lens sagittal depth and haptic design can mitigate prolapse and improve patient comfort.
Conclusion
Conjunctival prolapse in post-PK patients wearing scleral lenses can be effectively managed by reducing excessive vault and customizing haptic landing zones to the ocular surface shape. Careful lens design and follow-up are essential to prevent and address this complication.
References
- Walter et al, 2016 -- A proposed mechanism for scleral lens-induced conjunctival prolapse
- Caroline P, Andre M, 2012 -- Conjunctival prolapse, hooding, chalasis or… Contact Lens Spectrum
- Severinsky B et al, 2014 -- Scleral contact lenses for visual rehabilitation after penetrating keratoplasty
- Fadel D, 2020 -- Scleral Lens Issues and Complications: Their Recognition, Etiology and Management
- Schornack M, 2025 -- Scleral Lenses, Specialty Contact Lenses
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