April 19, 2003
Indications for therapeutic contact lens
Review of Ophthamology April 2003
• Chronic corneal edema due to endothelial failure results ultimately in bullous epithelial lesions that break down and cause pain and irritation. Bandage contact lens therapy relieves pain but doesn’t usually improve vision. A goal in therapy is to control pain while preventing corneal vascularization, particularly if the patient is a candidate for keratoplasty.
• Recurrent corneal erosions. There are several different conditions that may cause recurrent corneal erosions. Anterior causes include abrasive trauma, epithelial basement membrane dystrophy, and Reis-Bückler’s dystrophy. Stromal dystrophies such as granular and lattice dystrophy may also produce secondary corneal epitheliopathy.
• Persistent epithelial defects and ulcers. Bandage contact lenses are occasionally used in the management of persistent corneal epithelial defects and corneal ulcers, including post-infectious, trophic and autoimmune-related ulcers.
• infectious corneal ulcers to provide protection of the fragile, healing corneal epithelium while maintaining effective delivery of antibiotics via a depot mechanism.
A trophic corneal ulcer usually presents as a persistent epithelial defect with possible stromal ulceration and is often associated with decreased corneal sensation. The goal in treating this lesion is to promote epithelial healing and prevent the secondary stromal ulceration. A soft contact lens with good oxygen permeability may provide protection of the healing epithelium.
• filamentary keratopathy.
• Peripheral ulcerative keratitis is a thinning disorder of the corneal stroma often associated with an autoimmune etiology and inflammatory mediators causing collagen destruction of the stroma. A bandage lens can provide protection of the healing cornea and promote stromal vascularization to prevent further melting.
• Corneal irregularity. Bandage contact lenses can provide significant pain relief in conditions where the anterior surface of the cornea is elevated and irregular, sometimes even improving visual acuity. One such condition is filamentary keratitis, a disorder of irregular epithelial healing leading to mucous filament adhesion to focal epithelial micro-erosions of the cornea. Contacts lenses in this condition provide comfort and sometimes improve vision.
• Thygeson’s superficial punctate keratitis and
• superior limbic keratitis (SLK).
Posted by mehdi khanlari at April 19, 2003 11:04 PM