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Sjogren’s patient fit into scleral lenses

A 47 year old female was referred for contact lens evaluation. She was diagnosed with ocular cicatricial pemphigoid and Sjogren’s. These two conditions cause the eyes to be incredible red, irritated and dry. She suffers frm extreme dry eye.Her habitual scleral lenses are several years old and feel that they are getting dirty and fogging. She reports poor night vision with glare and halos. She reports only using preservative free sodium chloride solution to rewet her eyes throughout the day. Her lenses are about 2 years old, per patient.

She was 20/40 right eye and left eye with her current lenses. The front surface of the lenses had poor non-wetting surface and protein deposits. You can see in some of the images how deposited the surface of her lenses were. Both eyes exhibited poor tear film stability, inflamed bulbar conjunctiva, and formation of symblepharon. Symblepharon is a condition in which the under part of the eyelid starts to fuse with the white part of the eye. This can happen with patients that suffer from extreme dry eye. Due to her signs and symptoms, we felt that a custom Latitude lens would provide her the best comfort and vision.

The Latitude is a custom scleral lens that uses 3D imaging technology. The patient looks straight ahead, then up, then down, and the machine captures 3 D images in each gaze. Then, the software stitches the images together. This give the laboratory an incredible amount of information, so that a custom scleral lens can be designed and fabricated.

We worked with the lab to help design her new scleral lenses.

We dispensed her new lenses and she reported noticing immediate improvement in comfort and vision. You can see how well the new lenses fit her eye in the images below. Due to the instability of her tear film, we started her on Cequa as well as recommending preservative free artificial tears to replace the sodium chloride solution for the additional lubricating agents. Cequa is an eye drop intended to help with dry eye syndrome. We are very happy with how the new scleral lenses look and feel on this patient’s eyes!

Financial disclosures: I have no financial interest in any of the companies or products mentioned in this case report.

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