Scleral gel contact lenses in treatment of dry eyes.

Abstract

In the past I5 years various types of scleral contact lenses have been developed for the treatment of pathological conditions of the cornea and conjunctiva. Our previous investigations found the hydrophilic corneo-scleral lens very effective in the treatment of various inflammatory and degenerative corneal changes (Krejci, I970, 1971).In our present study the Czech hydrophilic corneo-scleral contact lens (Spofa lens) has been employed in the treatment of dry eye caused by various conditions such as keratoconjunctivitis sicca, filamentous keratitis, keratitis pemphigoides, Stevens-Johnson syndrome, xerosis, and keratosis corneae, and also in the therapy of dry corneal spots caused by chemical burns. Material and methodsThe lens is composed of a hydrophilic polymer of hydroxyethyl methacrylate cross-linked with ethylene glycol dimethacrylate. The thickness of the lens varies between 0-3 and I *3 mm. and the overall diameter between I4-0 and i6-8 mm. The lens has a corneal and scleral curvature and the variable saggital depth permits correct fitting according to the irregularities and pathological changes in the cornea and conjunctiva. These lenses differ from the conventional scleral lens in concept and design. It is not necessary to manufacture a mould of the anterior segment of the eye and then to form the lens over the mould as with the "hard" methylmethacrylate contact lens.The first and most essential part of the fitting technique is the ophthalmic and medical evaluation. A keratometer reading should be taken, a careful slit-lamp examination performed, and the diameter of the cornea measured. In all cases it is necessary to evaluate the microbiological condition of the cul-de-sac and to ensure that there is adequate space to fit the lens. The passage through the lacrimal sac has to be examined and the interpalpebral fissure and total size of the eye must be measured. Neither the apical clearance method, nor the usual alignment method is used. The lens is fitted to allow a I 0 to I-5 mm. distance between the apex of the cornea and the posterior surface of the lens. The average "hard" scleral lens has a minimum corneal clearance. The cornea-to-lens clearance is manufactured at 0-2 to 0 3 mm., evolving into a o i-O 15 mm. clearance when the lens is fitted. The gel lens relies on a corneal clearance of ten times this amount and produces a large pool of precorneal fluid.The slit-lamp examination is repeated to check the movement and centering of the gel lens as well as the thickness of the precorneal film. Fluorescein must only be used for any corneal disturbances with the lens off, otherwise the dye will be absorbed by the gel. The adaptation period based on the lens-cornea relationship is shorter than that required for the hard contact lens. It is possible to wear the gel lens for 8 to I2 hours daily from the first day and for 24 hours during the first week.The patients were shown how to insert and remove the lens and were instructed to boil the lens every 24 to 36 hours for 15 minutes in physiological saline. A...

Management of the dry eye in Sjogren's syndrome.

“…Since it is accepted that SS is a chronic benign inflammatory disease characterized by remissions and exacerbations, the results of this study have been withheld until several years have elapsed. For this reason also we make no attempt to comment on forms of treatment such as hydrophilic contact lenses (Gasset and Kaufman, 1971;Krejci, 1972) or motorized fluid delivery from reservoir glasses (Dohlman, I97I) which as yet we have not utilized in a large series of patients.Since there is at present nothing that will eradicate KCS in Sj0gren's syndrome, our aim has been to produce reliefofsymptoms, reduction in signs, and thus a reduced incidence of irreversible ocular damage over a long period of time.Patients studied 98 patients suffering from KCS were supervised for no less than 5 years. All were suffering from definite rheumatoid arthritis according to the American Rheumatism Association criteria (Ropes, Bennett, Cobb, Jacox, and Jessar, 1959).…”

“…Since it is accepted that SS is a chronic benign inflammatory disease characterized by remissions and exacerbations, the results of this study have been withheld until several years have elapsed. For this reason also we make no attempt to comment on forms of treatment such as hydrophilic contact lenses (Gasset and Kaufman, 1971;Krejci, 1972) or motorized fluid delivery from reservoir glasses (Dohlman, I97I) which as yet we have not utilized in a large series of patients.…”

BCLA CLEAR – Medical use of contact lenses

“…Most studies regarding scleral lenses and their potential benefits in the management of the ocular sequalae of Sjøgren syndrome are case series or cohort designs. Even though there are some reports from as early as the 1970's reporting on the benefit of scleral lenses for the treatment and management of dry eye disease [67,259,260], none specifically report on the benefits of dry eye signs and symptoms associated with Sjøgren syndrome. In 1992, a case series reported on the use of scleral lenses for ocular surface disease and dry eye [73].…”

“…Based on the evidence found in the literature, SJS patients benefit more from scleral lenses than other contact lens options. These benefits have been reported as early as the late 1960s in case reports [260,274,275]. A study from 1966 reported on the successful outcome of flush-fitting scleral lenses (moulded lenses that conform to the cornea and sclera) [274], which was soon followed by reports of SJS patients managed with this same type of scleral lens design and fitting approach [67,275].…”

Dry Eye Syndrome Preferred Practice Pattern®

“…Rigid gas-permeable scleral lenses have been used successfully in the treatment of severe dry eye for years. [145][146][147] Widespread use of scleral lenses 148 may be limited by fitting difficulties (particularly in the presence of conjunctival cicatrization), patient willingness and ability to wear the lenses, and high costs. Soft contact lenses may provide symptomatic relief in selected cases, particularly in the setting of filamentary keratitis.…”