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Ocular Surface Diseases

There are many different ocular surface diseases that may warrant a scleral lens for multiple purposes that can enhance comfort, vision, and/or quality of life. Many instances have shown where a scleral lens can be beneficial in cases such as:

Dry eye disease is the most common ocular surface disease affecting millions worldwide due to the environment, climate, autoimmune diseases, or inflammation due to a compromised ocular surface. In many cases, it is a combination; therefore, making this a multifaceted disorder and finding the underlying cause of these symptoms tricky. However, with different types of testing, management and treatment are possible for many who are affected by dry eye. A scleral lens will

Keratoconus is a disease in which the cornea begins to thin due to the weakened fibers and will bulge the cornea. This bulging will create an irregular corneal surface which causes vision to be distorted and blurred.

Pellucid Marginal Degeneration is a type of keratoconus in which the cornea thins and bulges, but it is commonly seen in the inferior cornea rather than central, as seen in keratoconus, and has a different topographical presentation. The bulge, like in keratoconus, will create distortions in the cornea causing blur, irregular astigmatism, double vision, and many other symptoms as seen in keratoconus. Fortunately, management and treatment are very similar.

Stevens-Johnson Syndrome is commonly seen as a response to different medications. SJS is a severe skin reaction to those medications that can also affect the ocular surface, specifically conjunctivalization of the cornea in extreme cases. In instances where the ocular surface becomes severely compromised, the visual potential is diminished; however, a scleral lens can provide increased comfort due to the damage SJS has does to the lids and ocular surface causing irritation.

Terrien’s Marginal Degeneration is a limbal cell disease of the cornea. It is a progressive non-inflammatory disease that can result in ocular discomfort and astigmatism due to the relaxation of the peripheral cornea. In many cases, glasses and soft toric contact lenses will provide adequate vision, but the disease may progress to the point where standard vision correction will not correct vision. With advances in fitting and scleral lens technology, even difficult cases in which there may be corneal ectasia can be addressed with a scleral lens. However, if the disease continues to progress and perforate the cornea, corneal keratoplasty should be considered.

Sjogren’s Syndrome is an autoimmune disease that affects the lacrimal gland, which is responsible for tears. This results in poor production of tears which will cause dryness of the eyes. If the eyes are not properly lubricated, the corneas can scar which will result in lasting damage. In this case, scleral lenses can provide lasting therapy by providing an environment where the eye is bathed in saline solution throughout the day and can provide lasting comfort.

Why Is a Scleral Lens a Viable Method of Treatment?

A scleral lens is a non-surgical method of treatment in many corneal cases, such as the ones discussed above. In many corneal pathologies, the environment or even physiological function (or lack thereof) can cause discomfort due to an abnormal ocular surface. In many ocular surface disease cases the shape of the cornea becomes distorted and this leads to improper tear distribution which leads to irritated and dry eyes. In many of these circumstances, vision is impacted due to pathological induced astigmatism or dry eye.

In these cases, where corneal ectasia or dry eye occurs, a scleral lens can aid in both of these aspects. The lens vaults over the affected the cornea and bathe the eye in saline, effectively creating a therapeutic environment to help with the irritation and dryness while simultaneously correcting vision. I believe in situations where a corneal transplant is not absolutely necessary, a scleral lens is the best solution to provide comfort with an added benefit of increasing vision potential.

References:

  1. TFOS DEWS II Report Executive Summary. Craig JP, Nelson JD, Azar DT. The Ocular Surface, Vol. 15, Issue 4, p802–812
  2. Improvement of chronic corneal opacity in ocular surface disease with prosthetic replacement of the ocular surface ecosystem (PROSE) treatment. Cressey A, Jacobs DS, RemingtonC, Carrasquillo KG. Am J Ophthalmol Case Rep. 2018 Feb 15;10:108-113. doi: 10.1016/j.ajoc.2018.02.010. eCollection 2018 Jun.
  3. Assessment of the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) scleral lens on visual acuity for corneal irregularity and ocular surface disease. Parra AS, Roth BM, Nguyen TM,et al. Ocul Surf. 2018 Apr;16(2):254-258. doi: 10.1016/j.jtos.2018.01.003. Epub 2018 Feb 6.
  4. Update in Current Diagnostics and Therapeutics of Dry Eye Disease. Thulasi P, Djalilian AR. Ophthalmology. 2017 Nov;124(11S):S27-S33. doi: 10.1016/j.ophtha.2017.07.022.
  5. Role of Scleral Contact Lenses in Management of Coexisting Keratoconus and Stevens-Johnson Syndrome. Rathi VM, Taneja M, Dumpati S, et al. Cornea. 2017 Oct;36(10):1267-1269. doi:10.1097/ICO.0000000000001310.
  6. An ocular surface prosthesis for keratoglobus and Terrien’s marginal degeneration. Mahadevan R, Fathima A, Rajan R, Arumugam AO. Optom Vis Sci. 2014 Apr;91(4 Suppl 1):S34-9. doi:10.1097/OPX.0000000000000200.
  7. RGP Scleral Lenses for Terrien’s Marginal Dystrophy. Ezekiel DF, Ezekiel DJ. https://www.clspectrum.com/issues/1998/january-1998/rgp-scleral-lenses-for-terrien-s-marginal-dystroph
  8. https://www.reviewdiseasehandbook.com/cornea/terriens-marginal-degeneration/
  9. http://www.sclerallens.org/sjogrens-disease