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Maylon Hsu, Michael Nolan, Amy Lin; Indications And Outcomes Of Scleral Contact Lens For Severe Ocular Surface Disease In The Acute Inpatient Setting. Invest. Ophthalmol. Vis. Sci. 2011;52(14):1960.
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Scleral lenses are rigid, gas permeable contact lenses that are usually custom fitted to an individual’s eye and used to manage a variety of ocular surface conditions. Recently they have been applied to the inpatient setting, using a preservative-free lubricating gel in the fluid reservoir to allow for the fit of the lens to be more forgiving against the shape of the ocular surface. This study reports the clinical courses and outcomes of 11 patients who were treated with a Jupiter scleral lens or a Prosthetic replacement of the ocular surface ecosystem (PROSE) device (previously known as the Boston ocular surface prosthesis) for acute ocular surface disorders as inpatients, predominantly in the intensive care unit.
Data was collected by retrospective chart review of all patients who had insertion of a scleral lens as inpatients since 2008. The indications for sclera lens placement, duration of lens use, ocular exam, complications, and clinical course were recorded.
Scleral lenses were used in 11 patients. Some patients required bilateral lenses, and one patient with severe periocular burns required repeated rounds of sclera lens therapy, resulting in a total of 23 cases. The age range was 2 weeks to 81 years old. Indications included non-healing epithelial defects, cornea ulcers or thinning, lagophthalmos, and failed tarsorrhaphy. All patients had some degree of exposure ranging from intermittent lag to over 10 mm of lagophthalmos. 6 patients had cicatricial changes; 5 due to periocular flame burns and 1 due to pemphigus vulgaris. 4 patients had lagophthalmos secondary to sedation or altered mental status. One patient had complete exposure of the globe due to agenesis of the eyelids at birth. The duration of sclera lens use ranged from 1 day to 40 days (Mean = 11.1 days, Median = 8 days). 4 patients expired because of their underlying medical condition. In 8 out of the 23 cases, the sclera lens was discontinued when a tarsorrhaphy was able to be placed. In all cases, corneal epithelial defects or thinning improved or remained stable.
The use of scleral lenses in the inpatient setting is a safe and effective means of protecting the cornea from exposure keratopathy and the complications of corneal melting or perforation. The scleral lenses provide a more stable precorneal tear film and decrease the frequency of eyedrop administration by nursing staff. The lenses are an alternative when tarsorrhaphy is not an option or has failed.
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