Dry eye is increasing in prevalence with an aging demographic. Therefore, we need to be cognizant of the increasing need to help these patients. Although most patients do well with traditional treatments, we may need to use alternative treatments for more severe cases. Several topical therapeutic strategies exist, but scleral lenses may play a role in the treatment of the most severe cases.
Scleral lenses are a unique lens design. They are made with high DK rigid gas-permeable lens material. These are large lenses that bear their weight on the conjunctiva and underlying sclera and completely vault the cornea. It is important to make sure that they do vault the whole cornea, including the limbal region. Although recommendations vary in the amount of clearance over the cornea that is needed, there should generally be 100-400 μm of clearance centrally. Our patient had 377 μm of clearance over the central cornea 5 minutes after lens application, as measured by optical coherence tomography (Figure 2).
Figure 2. Optical coherence tomography showing 377 μm of clearance between the scleral lens and cornea.
Scleral lenses are filled with unpreserved saline, which creates a saline bath over the cornea. This will provide significant support for corneal healing.
Medscape Optometry © 2013
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