Deep corneal stromal opacities associated with long term contact lens wear.

Abstract

Conclusion-The possible causes of these rarely reported opacities are discussed. (Br_J Ophthalmol 1996; 80: 21-24)

Microstructural assessment of rare corneal dystrophies using real‐time in vivo confocal microscopy

“…Many pathological corneal changes and degenerations can present as flecks or dots on slit‐lamp examination, 2–4 including cornea farinata, chrysiasis, atypical amiodarone keratopathy, corneal fleck dystrophy, pre‐Descemet’s dystrophies and flecks associated with contact lens wear 5 . We present three cases of ‘corneal stromal flecks’ with similar biomicroscopic characteristics but differing morphology, revealed by in vivo confocal microscopy.…”

In vivo confocal microscopy of pre‐Descemet’s membrane corneal dystrophy

“…Pre‐Descemet’s membrane corneal dystrophy is clinically characterized by the presence of numerous tiny pleomorphic opacities located in the deep stroma immediately anterior to Descemet’s membrane. However, many pathological corneas can present as posterior stromal opacities besides pre‐Descemet’s dystrophy, such as cornea farinata, corneal fleck dystrophy and flecks associated with long‐term contact lens wear 1,2 . It does not always allow an accurate clinical diagnosis on the basis of slit‐lamp biomicroscopy alone, and for some, a precise diagnosis is established only by histopathological examination after penetrating keratoplasty.…”

Deep stromal opacities

“…Pimenides et al 8 reported the cases of one male and three female long-term HEMA contact lens wearers (mean age 30.3 years; range 26-33) who demonstrated deep stromal opacities which were predominantly just anterior to Descemet's membrane. None had any history of corneal dystrophy.…”

“…Pimenides et al 8 reported that the density of the stromal opacities diminished over a period of months following cessation of contact lens wear in two cases. Hoang-Xuan 6 observed that more than 1 year after removal sequence that displayed the greatest number of microdots were selected for analysis.…”

“…Pinckers et al 2 reported that visual acuity was normal in the four patients they examined. All four patients in the case series reported by Pimenides et al 8 attained at least 6/9 Snellen visual acuity. The six patients examined by Holland et al 7 had visual acuities of 6/6 or better.…”