We had a very interesting patient today!
DR is a 63 year old female who was kindly referred by Dr. Hai Tran and Dr. Ksenia Stafeeva for a scleral lens evaluation.
She had a blepharoplasty on both eyes a few years ago. This is a very common eyelid procedure in which the skin on the upper eyelids is altered to lift the eyelids. After the procedure, the patient reported that she could never close her eye completely on the right eye. This led to severe dry eye and eventually a corneal melt.
She claims a similar situation happened with the left eye and the cornea was also scarred.
Due to the severity of her cornea, she had a tarsorraphy where the eyelid is stitched closed to help heal the cornea. She then had another tarsorraphy in the right eye, and this time, a permanent suture was placed.
She complains that her eyes feel very dry and uncomfortable all of the time. She is constantly in pain and feels like her eyes are always on fire unless she has them closed. She uses Xiidra twice a day in both eyes, 20% autologous serum tears throughout the day, artificial tears as needed, and gel at night. She tapes her eyelids shit at night, and she also wears a mask on top of her eyelids to keep moisture in.
She also complains that even with glasses, she sees very blurry and double in the right eye. She claims images are distorted in both the right eye and the left eye.
Her vision with glasses was 20/50 "double and ghosted) in the right eye and 20/40 "distorted" in the left eye.
Her right eye has a large scar measuring about 8mm wide by 7 mm long in the inferior central position. A portion of the scar is very thin (About 250um), so I reached out to the expert Dr. Sindt to find out if an impression would be safe. She gave me the green light and we took impressions of both eyes today.
Normally I take retinal images, topography, and more anterior segment photos but she was in too much pain and could not bear the light.
With a diagnostic scleral lens, she was able to achieve 20/20-2 in the right eye and 20/20-1 in the left eye! She also mentioned the double vision and ghosting was greatly improved.
We sent her impressions to the EyePrint lab today, and we are looking forward to her dispense! She should be a really fun case because not only is her vision going to be improved, but her eyes should find major relief with the scleral lenses. Super excited to help this patient! Thank you Dr. Tran and Dr. Stafeeva for thinking of us!
Meibomian glands on righty lower eyelid appear to be healthy.
Large scar tissue on cornea results in very poor and distorted vision in the right eye.
Pachymetry is very thin on the right eye due to the corneal scar.
Left eye wearing a scleral lens