Scleral lens wear can present unique complications not seen with other modalities. During a follow up with one of our scleral lens wear patients, we found this presentation after removing his lenses to assess his corneal health. The patient had been wearing his lenses for about 6 hours and had no chief complaints during his visit.
After instillation of fluorescein, an interesting limbal staining pattern was observed. One differential could be punctate keratitis due to inadequate limbal clearance. We checked the lens fit and ensured there was adequate clearance superiorly. Upon closer inspection, it appeared to be epithelial bogging. This can often trick us because it appears similar to normal corneal staining.
Epithelial bogging is a relatively benign complication associated with scleral lens wear. It is hypothesized as a response of the cornea due to prolonged exposure to the filling solution in the lens. We can see a similar response in our hands after a long washing dishes session. Another example would be when you’re the the bathtub and your hands start to get pruney. The wrinkly hands are a result of water entering into your skin and causing that strange appearance.
In scleral lens cases, the fluid from the bowl of the scleral lens can enter the cornea and create epithelial bogging.
As a result, it is very important to ensure that our patients are filling their lenses with fresh preservative free solution (not from multi-use bottles) every time.