Limbal Distress Syndrome Following Ill-Fitting Scleral Contact Lens In Keratoconus – A Case Series

Inflammation and edema within the limbal stem cell (LSC) niche, aka LSC distress, may be a precursor to LSC deficiency. Here, we report LSC distress following the use of an ill-fitting corneoscleral contact (CL) for advanced keratoconus (KC).

Private cornea clinic

We report the signs and symptoms of LSC distress in seven eyes of four patients with advanced KC who had ill-fitting corneoscleral CL. All patients were advised to discontinue CL use and were treated with topical prednisolone eye drops 4 times a day for 1 month, followed by a monthly taper over the next 3 months.

Patient’s ages was 11- 35  and spherical equivalent error was -8.25D to -24.00D. All patients presented with blurry vision, ocular pain, red eyes, photophobia, tearing, and irritation in the affected eyes. Slit lamp evaluation showed localized (temporal and nasal) conjunctival and ciliary injection, impingement of the CL with compression over the limbus, conjunctive and sclera, hyperemia and edema at the limbus, and localized superficial punctate keratopathy. Two eyes also showed temporally localized superficial and deep corneal neovascularization. All signs resolved after discontinuation of CL and topical steroids for 3 months. After resolution, all eyes were fitted with a rigid gas-permeable CL, without any intolerance or visual loss.  

Although rare, LSC distress syndrome can occur with ill-fitting corneoscleral CL in patients with advanced KC. If recognized early, this distress can be reversed with topical steroids and discontinuation of the offending CL, avoiding long-term CL intolerance or visual compromise.