Making a difference in quality of life with scleral lenses – Two clinical cases with neurotrophic ulcers

Abstract

The main use for scleral lenses is visual aid in irregular corneas. However, they are also beneficial as bandage lenses in severe ocular surface disease. Following cases illustrate two different ways to improve quality of life in patients with neurotrophic ulcers, a condition associated with hypoesthesia or anaesthesia of the cornea due to damage to the trigeminal nerve. Case 1 is a male patient who, at age 58 had a stroke that among other things resulted in a slow healing corneal ulcer. To shield the cornea a partial tarsorrhaphy was performed and soft bandage lenses were tried with little or no result. At age 71, he presented at the clinic with a central ulcer and BCVA 0.13. A scleral lens was fitted and two months later the ulcer was completely healed and BCVA had recovered to 0.6. The patient has now worn the scleral lens successfully for two years and the tarsorrhaphy has been reversed. Case 2 is a female patient who, at age 40, had an aneurysm causing an oculomotor nerve palsy leading to semi ptosis, inability to close the eyelid and total lagoftalmus. Over time an ulcer with neovascularisation caused by the corneal exposure developed. Not being able to move the eye, she also suffered from double vision and cosmetically the ptosis was disturbing. At age 48, she was referred to the clinic and a scleral lens was fitted. The ulcer healed completely after 6 weeks. Thanks to an excessive sagittal depth, the eyelid was elevated masking the ptosis. There was a possibility of improving BVCA from 0.05 to 0.3 but the vision was blurred intentionally with a high minus power to relief the double vision. The patient has now worn the lens successfully for two years.