Article

PEDIATRIC AND TEEN CL CARE

CL MANAGEMENT OF OCULAR TRAUMA IN CHILDREN

Ocular trauma is a common cause of unilateral vision loss in children. Complications resulting from ocular trauma include traumatic aniridia, irregular astigmatism, and traumatic aphakia or pseudophakia. The resulting refractive complications are well corrected by GP optics (Pradhan et al, 2014). However, in cases in which the iris is altered from injury, a soft colored lens can be used in combination with a GP lens to restore good vision and cosmesis.

Irregular Astigmatism

Irregular astigmatism is not correctable with standard glasses or soft contact lenses. In such cases, GP lenses are needed to mask the irregularity and to restore good optical quality. Corneal scarring creates a challenge in fitting due to dramatic changes in corneal curvature around the affected area. These irregularities in elevation may cause difficulties with centering a lens. A large-diameter GP will help with centration and provide enough depth to fit over the scar (Alipur and Hosseini, 2016).

Aphakia and Pseudophakia

Unilateral aphakia often results from surgical removal of a traumatic cataract after a penetrating ocular injury. This may be managed with an intraocular lens implantation. Nevertheless, the surgeries are often very complex due to damage to the capsular bag and may result in residual refractive error. In both cases, contact lenses can offer visual rehabilitation (Pradhan et al, 2014).

Aniridia

Traumatic aniridia occurs after a severe blow to the eyeball and is usually accompanied by rupture. It can also be seen after a perforating wound to the cornea (Romem and Singer, 1973). Patients who have traumatic aniridia are often photosensitive and can benefit from a colored contact lens to help block light. Additionally, if the cornea is involved, a GP lens can be utilized to correct the resultant irregular astigmatism.

This was the case for a 16-year-old male who presented with a history of penetrating corneal laceration from a screw that flew into his right eye. The injury also resulted in traumatic aniridia and cataract. The cataract was removed and replaced with an intraocular implant (Figure 1). Nevertheless, the patient was still left with significant residual irregular refractive error and photosensitivity. Thus, he was fitted into a soft colored contact lens piggybacked with a large-diameter corneal GP lens to restore vision, comfort, and cosmesis (Figure 2).

Figure 1. The cataract was replaced with an intraocular implant.

Figure 2. A soft colored lens piggybacked with a large-diameter corneal GP lens.

Summary

Ocular trauma in children causes decreased vision from various complications such as irregular astigmatism and aniridia. In these cases, soft colored lenses piggybacked with large-diameter corneal GP lenses provide the optics necessary to rehabilitate vision. CLS

For references, please visit www.clspectrum.com/references and click on document #275.