This photo shows the right eye of a 58-year-old female who has lagophthalmos secondary to previous surgery for acoustic neuroma. The patient’s cornea is neurotrophic and has central scarring secondary to exposure. After removal of a lid plate for managing her lagophthalmos, she had a partial temporal tarsorrhaphy that has been unsuccessful for full protection. The patient currently uses artificial tears t.i.d. OD and ophthalmic gel t.i.d. and q.h.s. OD. Her current visual acuity with glasses is 20/60.

She was referred for a scleral contact lens fit of her right eye. She was fit with a 16.5mm spherical-back-surface scleral lens designed from corneo-scleral topography. Vision in the right eye improved to 20/40 with the dispensed lens. There was some concern that application would be difficult secondary to the temporal tarsorrhaphy, but the patient was successful.

Exposure from paralytic lagophthalmos can lead to significant dryness and scarring of the anterior ocular surface. A scleral contact lens can protect the surface and provide improved visual acuity. At follow up, the patient was happy with the vision and comfort.