Clinical Report: Dimple Veiling in Corneal GP Lens Wearers

Overview

A 42-year-old female with high myopia and corneal GP lens wear exhibited discrete circular hyperfluorescent areas on the cornea identified as dimple veiling. Larger air bubbles under the lens indicated a steep fitting relationship, prompting lens refitting to improve corneal contact and reduce visual impact.

Background

Dimple veiling is characterized by small air bubbles trapped under corneal gas permeable (GP) lenses, causing indentations that pool sodium fluorescein dye and appear as bright, circular hyperfluorescent spots. It can be mistaken for punctate epithelial erosion (PEE) but differs in brightness and shape. While small amounts of dimple veiling are usually benign and resolve after lens removal, excessive dimple veiling can reduce vision and often indicates an improper lens fit, especially a steep fitting relationship. Adjusting the lens fit or adding fenestrations can alleviate this condition.

Data Highlights

Evaluation revealed several discrete circular hyperfluorescent NaFl areas corresponding to small air bubbles (dimple veiling) under the corneal GP lenses. A larger isolated air bubble was noted in the left lens, indicating a steep fit. These findings guided ordering new lenses to improve fit and reduce dimple veiling.

Key Findings

• Dimple veiling presents as bright, circular hyperfluorescent spots on the cornea due to small air bubbles under GP lenses.
• It can be confused with punctate epithelial erosion but is distinguishable by its brightness and shape.
• Small dimple veiling is typically benign and resolves after lens removal for minutes to hours.
• A large number or size of bubbles can reduce visual acuity and indicate a steep lens fit.
• Improving lens fit or adding fenestrations can reduce or resolve dimple veiling.
• Dimple veiling may be more common in irregular corneas than regular ones.

Clinical Implications

Clinicians should recognize dimple veiling as a sign of steep fitting corneal GP lenses and differentiate it from punctate epithelial erosion. While small amounts are not concerning if vision is unaffected, significant dimple veiling warrants lens refitting or fenestration to optimize corneal health and visual acuity. Monitoring and adjusting lens fit can prevent complications related to excessive air bubble entrapment.

Conclusion

Dimple veiling is a benign but important clinical sign of corneal GP lens fit, distinguishable from epithelial pathology. Appropriate lens fitting adjustments effectively resolve this condition and preserve visual function.

References

1. Stapleton et al. 2021 -- CLEAR - Contact lens complications