Clinical Scorecard: Online Photo Diagnosis: Scleral Lens Prolapse on Post-Graft
At a Glance
| Category | Detail |
|---|---|
| Condition | Conjunctival prolapse induced by scleral lens wear post-penetrating keratoplasty |
| Key Mechanisms | Negative pressure forces under scleral lens causing loose conjunctival tissue to prolapse, exacerbated by excessive central and peripheral vaulting |
| Target Population | Post-penetrating keratoplasty patients, especially elderly individuals wearing scleral lenses |
| Care Setting | Specialty contact lens clinics and ophthalmology practices managing post-graft patients |
Key Highlights
- Conjunctival prolapse is more common in elderly patients due to loose conjunctival tissue.
- Excessive central vault and poorly aligned haptic landing zones contribute to prolapse under scleral lenses.
- Modifying scleral lens parameters to reduce central vault and optimize haptic alignment improves prolapse.
Guideline-Based Recommendations
Diagnosis
- Perform slit lamp evaluation to identify conjunctival prolapse and assess scleral lens fit.
- Use anterior tomography to map corneal graft and peripheral scleral shape for lens design.
Management
- Adjust scleral lens parameters to reduce excessive central vault and improve haptic alignment.
- Consider alternating lens wear (e.g., corneal GP and scleral lenses) to minimize symptoms.
- Design haptic landing zones closer to the limbus to reduce peripheral vaulting.
Monitoring & Follow-up
- Follow up after lens settling to reassess vault and conjunctival prolapse improvement.
- Monitor for changes in lens clearance and conjunctival tissue response over time.
Risks
- Excessive vaulting can increase negative pressure under the lens, leading to conjunctival prolapse.
- Improper lens fit may exacerbate tissue prolapse and discomfort.
Patient & Prescribing Data
74-year-old male post-penetrating keratoplasty with corneal irregularity
Initial scleral lens with high vault caused conjunctival prolapse; redesign with reduced central vault and optimized haptic improved prolapse symptoms
Clinical Best Practices
- Use anterior segment imaging to guide scleral lens design in post-graft eyes.
- Customize scleral lens sagittal depth and haptic alignment based on graft and scleral shape.
- Monitor lens fit closely in elderly patients due to higher risk of conjunctival prolapse.
- Alternate between different lens types if needed to manage symptoms.
References
- Walter et al, 2016 - Mechanism for scleral lens-induced conjunctival prolapse
- Caroline P, Andre M. Conjunctival prolapse, hooding, chalasis or… Contact Lens Spectrum. 2012;27(4):56.
- Severinsky B et al. Scleral contact lenses for visual rehabilitation after penetrating keratoplasty. Cont Lens Anterior Eye. 2014;37(3):196-202.
- Fadel D. Scleral Lens Issues and Complications. Dougmar Publishing Group Inc.; 2020:49-52.
- Schornack M. Scleral Lenses. In: Fadel D, Barnett M, eds. Specialty Contact Lenses. 2025:109. Elsevier Inc.
- Girard LJ, Soper JW. Flush-fitting scleral contact lenses. Am J Ophthalmol. 1966;61(5 Pt 2):1109-1123.
- Ridley F. Contact Lens Fitting – theoretical considerations. In: Girard LJ, Soper JW, Gunn C. Corneal and Scleral Contact Lenses. 1967:214.
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