Year : 1983 | Volume
: 31 | Issue : 7 | Page : 931--933
Role of soft contact lenses in nonhealing corneal ulcers
DP Sharma, Manju Patni, Ravi Bajaj, SK Bardar
Upgraded Department of Ophthalmology, S.MS. Medical College and Hospital, Jaipur, India
D P Sharma
Upgraded Department of Ophthalmology, S.MS. Medical College and Hospital, Jaipur
|How to cite this article:|
Sharma D P, Patni M, Bajaj R, Bardar S K. Role of soft contact lenses in nonhealing corneal ulcers.Indian J Ophthalmol 1983;31:931-933
|How to cite this URL:|
Sharma D P, Patni M, Bajaj R, Bardar S K. Role of soft contact lenses in nonhealing corneal ulcers. Indian J Ophthalmol [serial online] 1983 [cited 2021 Sep 19 ];31:931-933
Available from: https://www.ijo.in/text.asp?1983/31/7/931/29709
Cases of non-healing corneal ulcers become a problem both for the patients and the treating Ophthalmologist. Such cases are usually due to viral ulcer, bullous keratopathy, marginal corneal ulcer and neuroparalytic keratitis. In such cases only when the conventional treatment failed, various authors,, have tried therapeutic bandage lenses with varying results. Therefore, it was thought of interest to study the role of soft contact lenses in non-healing corneal ulcers.
MATERIAL AND METHODS
One hundred cases of non-healing corneal ulcers (not healed in 20 to 30 days) were selected from the Upgraded Department of Ophthalmology, S.M.S. Hospital, Jaipur. The cases included were: 50 cases of bullous keratopathy, 27 cases of viral corneal ulcer, 8 cases of neuroparalytic keratitis, 8 cases of marginal corneal ulcer, and 7 cases of corneal ulcer after facial palsy.
Corneal scrappings were taken and sent for culture and sensitivity. Whenever needed the ulcers were carbolised or Iodine/Cryo cauterisation (in viral corneal ulcers) was done. Keratometery was done and lenses selected as per B.C.O.R. When the ulcers were so deep or irregular that the keratometery was not possible, a sauflon piano T was selected. The lenses were sterilised by boiling them in 0.9% normal saline for 8 to 10 minutes. Whereever refraction was possible we fitted powered soft lenses. Depending on the disease and culture sensitivity report the desired treatment was given.
a) Bullous Keratopathy: The sauflon T-70% gave perfect symptomatic relief [Table 1] in these cases.
In cases of severe painful bullous keratopathy a relatively tight hydrophilic bandage lens gave better relief.
b) Non-healing corneal ulcer.
Improvement of the corneal thickness in marginal corneal ulcer (degeneration) was observed after wearing sauflon T lenses. In this group all the corneal ulcers healed within 10 days.
Soft lenses have revolutionised the management of non-healing corneal ulcers and bullous keratopathy. In our experience they can be used safely for the relief of symptoms, speedly healing of corneal ulcer and improvement ofvision. Relief of pain was virtually guaranted with the sauflon T-70% lenses as the exposed nerve endings were well covered with soft lenses , BUT it must be remembered that Cycloplegia is necessary to relieve the iritis frequently present in these patients. If the lens is properly fitted and the iritis is well controlled it is very rare for the patients to have significant residual discomfort, provided that they wear the lens constantly (24 hrs. a day for months at a time).
The complications with sauflon lenses recorded were mucous and mineral deposits on the lens, conjunctivitis, corneal infiltration, protein deposits and superficial corneal vascularisation. In these cases, the lenses were removed, thoroughly cleaned and disinfected or whenever needed the lenses were replaced and advised check-up every week. In cases of bullous keratopathy, the bandage lens act like a splint over the cornea thereby checking bullae formation, and even if any bulae remains, no rupture occurs by blinking of lids.
The improvement in the vision in bullous keratopathy can be just as important as the relief of pain, but it is less predictable. Stromal haze contributes little to the loss of vision, the primary cause is anterior and posterior irregular astigmatism. In early cases, where there are not many folds in Descemet's membrane, the soft lenses will eliminate the anterior irregular corneal astigmatism and will usually improve vision, further improvement may be obtained with the administration of 5% sodium chloride as needed.
After wearing of these bandage lenses and use of appropriate drugs it was observed that the drugs had better and prolonged effect and the ulcers healed in a period of 4 to 10 days. In these cases the lenses were used for 1 to 6 months depending on the case and no recurrence was recorded. In these cases the visual improvement and pain relief was obtained which ha's made surgery unnecessary. Of even greater importance is the fact that this is a reversible procedure that does not preclude later surgery in cases where results are unsatisfactory. After healing of the corneal ulcers these lenses correct anterior irregular corneal astigmatism by replacing the damaged superficial refractive layers of the cornea with smooth and optically perfect surface.
Sauflon T-70% lenses were fitted in 100 cases of non-healing corneal ulcers, which included 50 cases of bullous keratopathy, 27 cases of viral corneal ulcers, 8 cases of marginal corneal ulcers, 8 cases of neuroparalytic keratitis and 7 cases of corneal ulcers after fascial palsy. The lenses provided complete relief of symptoms, early healing of corneal ulcers (4 to 10 days) and marked visual improvement. The complications recorded were mucous, mineral and protein deposits on the lenses, corneal infiltration, conjunctivitis and superficial corneal vascularization.
|1||James, V; Aquavella: 1977, Fitting guide for hard and soft contact lenses.|
|2||Jose, N.K; Violante, A.C. and Prado. J. Jun 1977. Therapeutic use of hydrophilic contact lenses. Res. bras.oftal. 36, 755.|
|3||Sharma, D.P., Mathur, M., and Shrivastava, S.:Role of soft contact lenses in non-healing corneal ulcers, Proceedings of VIII Rajasthan Ophthalmological Conference, Kota, 1981.|