|Year : 1984 | Volume
| Issue : 6 | Page : 519-521
Role of soft contact lens in ocular surface problems
VK Dada, VK Kalra, SK Angra
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
V K Dada
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences Ansari Nagar, New Delhi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dada V K, Kalra V K, Angra S K. Role of soft contact lens in ocular surface problems. Indian J Ophthalmol 1984;32:519-21
|How to cite this URL:|
Dada V K, Kalra V K, Angra S K. Role of soft contact lens in ocular surface problems. Indian J Ophthalmol [serial online] 1984 [cited 2019 Dec 6];32:519-21. Available from: http://www.ijo.in/text.asp?1984/32/6/519/30858
The ocular surface epithelium includes corneal epithelium and the surrounding bulbar conjunctival epithelium which in many ways is a functional unit . These tissues develop in response to unique morphogenetic influences, exhibit unique patterns of anatomical and biological differentiation and fall prey to numerous disease processes.
Soft contact lens helps in surface disorders by preventing recurrent surface breakdowns and by restoration of optical integrity of the surface. The present study is aimed to highlight the efficacy of high hydrophilic extended wear soft lens in the management of surface disorder.
| Materials and methods|| |
In the last 2 years 102 eyes with surface disorders were fitted with Sauflon 70% extended wear lens at the Contact Lens Clinic of Dr. Rajendra Prasad Centre for Ophthalmic Sciences, New Delhi. The patients ranged in age from 20 to 90 yrs. Trial fitting was done by best fitting criteria by judging the lens movement, centering, air bubble position, edge indentation and observing the ease of displacement of lens by forced movements.
After initial fitting, the eyes were examined at 4 hrs., 24 hrs., 48 hrs., 1 week, 2 weeks and thereafter at monthly intervals. Depending upon the individual constitution the lens hygiene was maintained by the periodic removal for cleaning and sterilization. Appropriate adjunct treatment in the form of eye drops was used over the lenses to avoid lens problems like drying, displacement, deposits and ocular problems like blurred vision, infection, iritis and glaucoma.
| Observations and discussions|| |
Herpes Keratitis :- The cases included those of metaherpetic keratitis and combined epithelial and stromal disease and cases of central ulcers in zoster keratitis with corneal anaesthesia. The lenses were given for three to four weeks. In addition to soft lens, antibiotic drops, artificial tears, diluted steroids were used. Cycloplegics were added if there was an associated iritis. A high success rate was achieved in cases who failed to respond medically. The probable mechanism of action is protecting the cornea from abrasive lid action and by keeping the ulcer well lubricated through retardation of tear film evaporation.
In cases of bullous keratopathy there was an immediate relief of pain and discomfort after lens insertion. Within 48 hrs. smaller bullae disappeared. Additional 5% saline was used in cases who did not respond to lens therapy alone. If the vision in the eye is poor and does not improve with aphakic correction we prefer to give a plan. Variety of lens even in aphakic as it is much thinner and therefore more oxygen permeable.
Recurrent corneal erosions :- The basic problem in these cases is an abnormality in basement membrane of cornea which normally acts as a bond between epithelium and stroma. The main line of treatment in such cases is to promote epithelial regeneration with maintenance of an intact ocular surface for sufficient time to allow reformation of normal basement membrane complexes Failure to respond to epithelial debridement and medical management is usual. The lenses were fitted with large diameter and with a steeper fit. The criteria of fit was minimal or no movement of lens and yet no vascular compression by the edge. A close watch was given to such lenses to observe oxygen deprivation of fitted corneas. Lenses were continued for 4-6 weeks even after epithelization had occurred.
Chemical Burns :- After conventional treatment for chemical burns, 6 eyes were fitted with E.W.L. Only two cases epithelized in 4 weeks but even in these there was gross superficial vascularization of cornea. In the remaining four cases it was found that excavation of ulcerative keratitis slowly grew deeper resulting in perforation. This deterioration and silent perforation may be due to detrimental effect of soft lens on corneal metabolism and collagenase activity
Neuroparalytic keratitis :- Theoretically speaking, use of soft lenses in anaesthetic cornea can be complicated by superadded infection without patient having any symptom. We have an experience of 5 eyes with C.P. angle tumors with neuroparalytic keratitis who did not respond to medical treatment and bandage and did so favourably in 3 weeks with the use of soft lens.
Stevens Johnson Syndrome :- Adjunct therapy with saline, wetting agents, methylcellulose drops was instituted in all cases alongwith the use of E. W L. Local antibiotics and 1:10 dexamethasone were used when indicated. Certain observations were made during the study.
i.These corneas are highly susceptible to infections.
ii.Advanced cases cannot be satisfactorily fitted with hydrophilic lenses.
iii. In moderately dry eyes, it is sometimes necessary to substitute lenses of low hydration than conventional lenses.
iv. Artificial tears have to be used frequently to keep the lenses moist.
Post Surgical epithelial defects :- The cases belonged to large epithelial defects over the grafted corneas exposure keratitis following facial palsy, over correction during ptosis surgery and epithelial defects during post operative phase in diabetes mellitus. An excellent response was observed in majority of cases who did not respond to semi-pressure patching and medical treatment. The probable mode of action of lenses in such conditions may be that polished back surface of lens gives a better base for epithelium to grow than the surface of lid or avoidance of rubbing movements of lid over the defective corneal epithelium or prevention of desiccation of corneas due to presence of a wet membrane on it.
| SUMMARY & CONCLUSIONS|| |
Sauflon 70% was used as an extended wear lens in 102 eyes of ocular surface problem (Inflammatory. degenerative, traumatic, neuroparalytic or dermatological). In 81.37 of conditions there was a definite improvement in the ocular signs. Failure was due to superadded infection or advanced corneal pathologies. A high success rate was achieved due to rapid relief of pain, quick epithelization of ulcerative lesions and accomplishment of optical adequacy. The mechanism may be protective, buffering, splinting or providing a waterlogged transparent membrane by the soft lens in such pathologies.
| References|| |
Hales R.H. : 1982, Contact lenses -a clinical approach to fitting, Williams & Wilkins London.
Stein H.H. & Slatt B.J. : 1977, Fitting Guide for hard and soft contact lenses. The C.V. Mosby Co. St. Louis.
Thoft R.A. & Friend J. : 1979, International Ophthalmological Clinic. Vol. 19, No. 2.
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