Online Photo Diagnosis

By Gregory W. DeNaeyer, OD

This photograph shows a superior epithelial arcuate lesion (SEAL) of a 36-year-old patient’s left eye. The patient had been successfully wearing a specialty soft keratoconus design contact lens to manage his vision after developing post-laser-assisted in situ keratomileusis (LASIK) ectasia. His current soft lens had parameters of 8.5mm base curve, 14.8mm diameter, and -3.25 -2.00 x 105 power. The material was hioxifilcon A (60% water), and the center thickness was 0.46mm. Visual acuity measured 20/40.

SEALs are epithelial defects near the superior limbus that result from mechanical trauma secondary to a soft contact lens. The patient had reported recent irritation and decreased vision. Updated topography of his left eye showed progression of his ectasia.

The patient was refit into a scleral contact lens to eliminate contact lens-related mechanical trauma and to mask his increased irregularity. The dispensed scleral lens improved his vision to 20/25. His corneal defect will be monitored for resolution during follow-up examination. Corneal cross-linking evaluation will be recommended.