A number of factors may contribute to delayed ocular irritation and redness after successfully fitting a patient with scleral contact lenses. One of the possible contributors to these symptoms is a hypersensitivity to solutions that are used in conjunction with scleral lenses.
A 59-year-old patient with moderate keratoconus was bilaterally fit into scleral R(GP) lenses after failing with corneal R(GP) lenses secondary to lens instability. The scleral lenses were dispensed and the patient was prescribed a multipurpose solution for cleaning/disinfection. He was instructed to fill the lenses with bottled, non-preserved saline solution prior to lens application. His vision was 20/20 in each eye, and the scleral lenses showed sufficient corneal vault and no conjunctival blanching.
A few months after successful wear the patient started to complain of increasing redness and irritation with lens wear. His visual acuity remained 20/20. Examination revealed moderate conjunctival injection and congestion beneath the scleral haptics (see figures 1 and 2 for OD and OS). Slit lamp exam after lens removal showed mild epitheliopathy of both eyes; otherwise all other findings were unremarkable.
Figures 1 and 2: large scleral lens manifestation OD (top) and OS (bottom)
With this particular scenario, it might be tempting to jump to the conclusion that the symptoms of irritation/redness/congestion are due to the scleral lenses fitting too tight and causing a complete seal-off. However, in this case the lenses fit without excessive compression and there was no evidence of conjunctival blanching. Since the patients symptoms were delayed, it is reasonable to consider solution hypersensitivity. The patient was instructed to immediately discontinue his multipurpose cleaner and was switched to a hydrogen peroxide care system. He was to continue filling the lens with bottled non-preserved saline solution. The switch to the hydrogen peroxide care system immediately resolved the patient’s symptoms.
In many instances, conjunctival injection and congestion in a scleral lens patient are caused by a lens that is fit too tight with secondary seal-off. However, if there is lack of evidence supporting excessive lens compression and the symptoms are delayed, consider solution hypersensitivity
Greg DeNaeyer is a 1998 graduate of The Ohio State University College of Optometry. He completed a hospital based residency at the Columbus VA Medical Center. Greg joined Arena Eye Surgeons in 1999 and is currently the Clinical Director. His primary interest is specialty contact lenses.
Greg is the president of the Scleral Lens Education Society and is a Fellow of the American Academy of Optometry. He is a contributing editor for Contact Lens Spectrum and a contributor to Review of Cornea and Contact Lenses and Optometric Management. Currently his primary research is focused on profilometer designed scleral contact lenses, scleral lenses that correct higher order aberrations, and topical drug delivery devices. He has consulted for Visionary Optics, Essilor, Inspire Pharmaceuticals, B+L, and Aciont.