A 43-year-old female presented for cosmetic rehabilitation of her left eye. She reported childhood blunt trauma from a soccer ball resulting in permanent disfigurement. The patient works as a nurse and expressed self-consciousness because patients frequently asked about the appearance of the eye.

Exam Findings

Examination revealed corneal opacification, phthisis bulbi, and a sensory exotropia of the left eye. Ocular motility was relatively preserved despite the disfigurement. After discussion of options, including a scleral shell prosthesis and a custom-tinted soft contact lens, the patient elected a prosthetic soft contact lens to preserve ocular movement and reduce cost.

A clear diagnostic lens was first evaluated for fit and comfort, then was custom tinted in-office using a single brown iris color. Because the patient’s natural irides were dark, an opaque black pupil was not required. The final lens provided satisfactory cosmetic improvement while maintaining ocular motility (Figure 2). Additionally, the patient reported high satisfaction.

Discussion

Custom-tinted soft contact lenses can provide cosmetic rehabilitation for patients who have ocular disfigurement such as phthisis bulbi, corneal scarring, iris defects, or leukocoria. Compared with a hand-painted scleral shell, a prosthetic soft lens is often less expensive and typically preserves more natural ocular movement. A clear diagnostic lens should be fitted before tinting to ensure adequate centration, movement, and comfort. Accurate color matching is critical because modifications are difficult once the tint has been applied. If significant ocular irregularity prevents acceptable soft lens fitting, a scleral shell prosthesis may be preferred.

Conclusion

Custom-tinted soft contact lenses represent a conservative, cost-effective alternative to traditional ocular prostheses for selected patients with ocular disfigurement. This case demonstrates that substantial cosmetic improvement can be achieved while preserving comfort and natural ocular movement, resulting in high patient satisfaction.