Scleral contact lens usage in patients with complex blepharoptosis.

PURPOSE: To evaluate the efficacy of scleral contact lenses (ScCLs) as an alternative or as an adjunct to surgical correction for the management of complex ptosis. METHODS: A retrospective case-note review was used to determine the subjective function and cosmetic acceptability of the lenses. Digital photographs were taken, both with and without the lens in place; analytic software was used to assess the vertical height of the palpebral aperture (PA) and the upper margin-reflex distance. Three masked observers independently graded the photographs for cosmesis as "good," "moderate," or "poor." RESULTS: Ten patients (6 male) had been wearing ScCLs in 14 treated eyes for between 1 and 40 years (mean, 10.3 years; median, 3 years). Without a lens, the mean PA was 4.9 mm (median, 5.1 mm; range, 1.7-7.1 mm), increasing to 9.5 mm (median, 8.9 mm; range, 5.8-14.8 mm) with the lens in place (p < 0.005). Likewise, the upper margin-reflex distance increased from 0.39 mm (median, 0.03 mm; range, 0-2.4 mm) without a lens in place to 3.1 mm (median, 2.7 mm; range, 1.5-5.8 mm) with lens wear (p < 0.005). In 6 patients with unilateral ScCL wear, mean PA was 10.4 mm in the treated eye and 8.4 mm in the eye without a lens (p = 0.22). All patients who were wearing ScCLs long term found them to be both comfortable and cosmetically acceptable. On subjective grading of photographs, however, the cosmesis was judged as "good" in 22%, "moderate" in 64%, and "poor" in 14%. CONCLUSION: In some patients, ScCLs provide a well-tolerated and practical long-term solution to safely elevating the upper eyelid in which complex ptosis is present. The patients in our cohort seem to be satisfied with the cosmesis, although there are some limitations to this aspect when viewed subjectively.

Therapeutic and ocular surface indications for scleral contact lenses.

ABSTRACT Contrary to popular perception, the large size and scleral bearing surface of scleral contact lenses (ScCLs) can be beneficial in the management of certain ocular surface disorders. They can provide retention of a precorneal tear reservoir for corneal hydration with total protection from the external environment and from the lid margins and lashes. They can relieve pain, prevent exposure keratitis, and enhance epithelial healing. The use of ScCLs is limited in large part by ophthalmologists' perception of excessive complexity. Actually, while some cases are challenging, many are straightforward. This review summarizes indications for therapeutic use of ScCLs and describes techniques and considerations that contribute to their clinical success.

A keratoconus fitting system using the axial profile to establish optimum lens parameters.

This paper describes the application of a fitting system for keratoconus defined according to the integrated configuration of the optic and periphery, referred to as the axial profile. Incremental steps are arithmetic for a given total diameter across the range necessary for keratoconus and increased or decreased by varying the back optic zone radius (BOZR) and the axial edge lift (AEL) in combination, or by retaining a constant BOZR and reducing the AEL. An introductory section discusses selection of initial rigid trial corneal contact lenses for keratoconus and arrival at an optimum end point to the fitting process.