When Symptoms Do Not Accurately Represent What Is Happening: Severe Inadvertent Idiopathic Corneal Stromal Thinning

A young male attended our clinic reporting long term visual acuity decrease in his left eye. Prior to this visit, he was being followed up in our institution due to visual disturbances secondary to excessive corneal incurvation after hypermetropic LASIK performed in another institution and severe Demodex-suspected blepharitis with poor treatment compliance. It should be noted that this visit was performed amidst the national pandemic mobility restrictions. He presented with unilateral (left eye) decreased visual acuity (0.2 Snellen), no pain, no discharge and a severe corneal central corneal thinning. No inflammatory signs or epithelial defect were present. There were no relevant findings in his right eye, apart from the previously hypermetropic LASIK flap.

We describe the initial and long-term treatments applied in this case that range from intensive lubricating schemes, blood derived eyedrops, advanced eyelid treatments (Blephex and Intense Pulsed Light) to personalized rigid contact lens adaptation. This tailored approach allowed us to achieve contact lens best corrected visual acuity Snellen of 1, with a partial recovery in stromal thickness secondary to epithelial hypertrophy without disease relapses or treatment side effects.