Clinical Scorecard: Online Photo Diagnosis
At a Glance
| Category | Detail |
|---|---|
| Condition | Peripheral corneal epithelial bullae due to scleral lens wear |
| Key Mechanisms | Mechanical compression from inadequate lens vaulting |
| Target Population | Patients fitted with scleral lenses, particularly those with larger corneal diameters |
| Care Setting | Ophthalmology clinic |
Key Highlights
- Peripheral corneal epithelial bullae observed nearly 360º in both eyes
- Bullae are mechanical in nature, not due to hypoxia
- Inadequate vaulting chamber leads to lens landing on peripheral cornea
- Refitting with a larger diameter lens is essential to resolve the issue
- Immediate refitting is recommended to prevent long-term corneal damage
Guideline-Based Recommendations
Diagnosis
- Evaluate lens fit with fluorescein to assess contact point
- Identify mechanical bullae through slit lamp examination
Management
- Refit with a larger diameter scleral lens
- Consider lens design variations for optimal fit
Monitoring & Follow-up
- Follow up regularly to assess for symptoms and complications
- Monitor corneal health to prevent scarring
Risks
- Potential for long-term corneal tissue changes if left untreated
- Increased symptoms over time if mechanical compression persists
Patient & Prescribing Data
Individuals with refractive errors requiring scleral lenses
Larger diameter lenses can alleviate mechanical compression and prevent epithelial bullae
Clinical Best Practices
- Ensure adequate vaulting in scleral lens design
- Educate patients on the importance of lens fit and follow-up
- Address any signs of corneal compromise promptly
References
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