Contact Lens Case Reports
Central Epithelial Erosions in Orthokeratology
By Patrick J. Caroline, FAAO, & Mark P. André, FAAO
Central epithelial erosions in orthokeratology (OK) may occur early in the procedure or months after beginning the modality. The most common form of early onset epithelial disruption occurs within the first days of lens wear, secondary to the minimal apical clearance present with OK lens designs. During the initial stages of central epithelial compression, the thinned tear film can result in a transient epithelial punctate erosion, which commonly resolves within two to five days (Figure 1).
Figure 1. Early onset corneal staining in orthokeratology.
One of the more common late-onset complications of orthokeratology is deposit formation on the anterior and posterior surfaces of reverse geometry lenses. The deposit formation can result in epithelial defects that range from mild punctate erosions to a frank epithelial defect.
Removing Lens Deposits
This month, we look at a 10-year-old male with a 12-month history of orthokeratology for his –5.00D of myopia. The patient had been doing well with his OK lenses until one week prior to his routine one-year follow-up visit. His entering visual acuity was 20/60 OD and 20/30 OS. He also complained of recent discomfort in the morning immediately upon removal of the right contact lens. A slit lamp exam showed a small central epithelial defect on the right eye and mild central superficial punctate keratitis (SPK) on the left eye (Figure 2). Examination of the lenses showed both to be heavily deposited, so we cleaned them with the Menicon Progent system (Figure 3).
Menicon Progent is an extra strength monthly cleaner for GP (fluorosilicone acrylate) contact lenses. Two solutions are mixed together, and the lenses are soaked in the solution for 30 minutes. Solution A consists of sodium hypochlorite (a bleach), and solution B is a salt potassium bromide. The combined solutions remove a wide range of deposits and disinfect the lenses.
The single 30-minute cleaning dramatically decreased the lens deposition. The patient (and his parents) were instructed to again treat the lenses later that evening and to begin contact lens wear in two days. The parents called in one week to report that the patient was once again doing well, with improved visual acuity and no discomfort following the morning lens removal.
Figure 2. Late onset epithelial defect secondary to excessive deposit formation.
Figure 3. The patient’s contact lenses preand post-Menicon Progent treatment.
We have found the Progent cleaner to be extremely effective with our OK patients as an adjunct cleaner every two to four weeks. CLS
Patrick Caroline is an associate professor of optometry at Pacific University. He is also a consultant to Contamac. Mark André is an associate professor of optometry at Pacific University. He is also a consultant for CooperVision.