Alternative Applications Of Scleral Lenses In Corneal Irregularities

Scleral lenses are traditionally used in cases of keratoconus, but their application extends to various corneal irregularities. This case highlights the use of scleral lenses in a 16-year-old patient with corneal scarring and neovascularization secondary to a history of phlyctenular keratoconjunctivitis. The report emphasizes the role of scleral lenses in improving visual acuity and ocular surface protection in non-keratoconus conditions.  

Our clinic selects approximately 50 patients annually for scleral lens prescription . While 41 of these cases involve keratoconus, the remaining 9 include indications such as post-surgical ectasia, corneal scarring, and other corneal pathologies. This case underlines the importance of scleral lenses as an alternative solution for visual rehabilitation in non-keratoconus patients.

A 16-year-old female presented with complaints of poor vision. Her uncorrected visual acuity (VA) was 20/200 in the right eye (OD) and 20/630 in the left eye (OS), with pinhole improvement to 20/100 (OD) and 20/63 (OS), but no further correction with spectacles. Slit-lamp examination revealed anterior stromal scarring and corneal neovascularization.The patient reported a history of phlyctenular keratoconjunctivitis diagnosed six years ago, with treatment reportedly continuing for one year. Given the severity of corneal irregularity and lack of adequate correction with conventional methods, scleral lenses were indicated.  

A custom scleral lens fitting was performed with the following parameters:  

Right eye (OD): Prolate design, sag 4920, diameter 16.0 mm, base curve 8.5, landing zone curve (LCA) +34, power +3.0D, peripheral curves +2/+1/+2/+1.  

Left eye (OS):Prolate design, sag 4960, diameter 16.0 mm, base curve 8.5, LCA 0, power +2.0D, peripheral curves +2/+1/+2/+1.  

With scleral lenses, the patient achieved a remarkable improvement in VA: 20/32 in the right eye and 20/25 in the left eye. The patient reported significant enhancement in visual function and comfort, highlighting the effectiveness of scleral lenses in managing corneal scarring and irregular astigmatism. 

While scleral lenses are widely recognized for keratoconus management, they serve as a valuable tool for various corneal conditions, including post-inflammatory scarring and neovascularization. Their ability to vault over the cornea, providing a smooth optical surface and promoting ocular surface healing, makes them an essential option in complex cases. This case demonstrates that scleral lenses should be considered in a broader spectrum of corneal pathologies where conventional corrections fail, offering patients improved vision and quality of life.