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E.K. Jacobson, J.C. Affeldt, M.R. Agarwal; Contact Lens Related Limbal Stem Cell Deficiency . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1405.
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Purpose: Limbal stem cell deficiency (LSCD) is a serious ocular surface disorder manifested by chronic keratitis, neovascularization, and conjunctivalization. It has been ascribed to a variety of well known causes, but only 5 cases have previously been associated with contact lens wear (Puangsricharern, Tseng, Ctyologic Evidence of Corneal Diseases with Limbal Stem Cell Deficiency. Ophthalmology, Vol. 102, Number 10, October 1995). The purpose of this report was to document for the first time the clinical features of a series of patients with contact lens related LSCD. Methods: The diagnosis of LSCD was based on clinical findings including persistent ocular inflammation, punctate keratopathy, and active superficial corneal neovascularization despite a minimum three-month cessation of contact lens wear, coupled with aggressive (punctal occlusive) treatment of dry eye and/or neurotrophic keratitis. Corneal sensation was quantitated using the Cochet-Bonnet aesthesiometer, while tear production was measured by Schirmer method using topical anesthesia. Results: Six patients were identified with contact lens related LSCD. One patient wore hard lenses, while the remaining 5 wore soft. Mean age was 32, average length of wear was 15.4 years, mean wearing time was 9.4 hours, and all patients claimed good lens cleaning and replacement protocol. Mean corneal sensation and tear production were both significantly reduced as compared to controls, measuring 36.3mm versus 56.3mm (P=0.01) and 10.2 versus 16.4mm (P=0.04) respectively. Conclusions: Contact lens overwear related LSCD represents a potentially blinding but preventable cause of ocular surface disease. This frequently overlooked disorder can be recongized by the clinical constellation of chronic keratitis, neovascularization, and conjunctivalization which improves slowly if at all despite contact lens cessation. Contact lens related LSCD can develop with both soft and hard contact lenses, and appears to be associated with long-term contact lens wear, aqueous deficient dry eye, and corneal hypoesthesia.
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