Article

MARCH 2017 ONLINE PHOTO DIAGNOSIS

Case History

This patient is a 72-year-old female who has successfully worn GP lenses for several decades. She has been wearing this lens design for six years with no complaints, returning for follow up at least every two years. Early in February this year, she visited us complaining of corneal pain. We identified a relatively extensive lesion due to epithelial erosion in the lower cornea at 6 o’clock to 7 o’clock. We instructed the patient to discontinue lens wear and prescribed Epitezan (retinol acetate 10,000 IU, amino acids 2.5%, methionine 0.5%, chloramphenicol 0.5%, Allergan, available in Brazil) t.i.d. for three days, then we asked her to return for re-evaluation.

We first suspected that the lesion was a corneal infection, but the eye was calm and there was no clear evidence of inflammatory response or abnormal tearing. We concluded that the lesion was due to some unknown traumatic event. Because the outer epithelium was damaged (Figures 2 and 3), we opted to use Epitezan because it helps the cornea to heal and also has antibiotics to prevent infection.

Figure 2. Biomicroscope view of fluorescein staining at the lesion.

Figure 3. Slit lamp view at 45º showing damage to the outer epithelium.

Follow Up

After three days of treatment, the cornea had healed about 70%, so we instructed the patient to continue administering Epitezan for three more days to completely heal the cornea so we could refit her GP lenses. It was clear to us that the lesion was due to some traumatic event. The patient told us that she remembered having an accident applying the lens prior to her pain symptom. We thought maybe her long nails caused it, but she explained that she was off-balance when she applied the lens and blinked during application, making the lens rub against the lower cornea.

Case Resolution

One week after her initial visit, the cornea had healed and presented no fluorescein staining. The epithelium was intact, and there was a very light scar, difficult to see even with biomicroscopy (Figure 4).

Figure 4. The cornea was completed healed after treatment.

Comments

We examined the lens and the edge and polished it to prevent a recurring lesion while she awaited a new pair of GP lenses. In cases like this, it is important to make sure that there is no inflammatory response and to observe the overall aspect of the eye. If in doubt, a broad-spectrum antibiotic may be prescribed as a prophylactic measure, especially if you are not sure of the cause of the lesion. Careful and methodic follow up is necessary until it proves safe to refit the patient or to instruct the patient to return to lens wear.