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ONLINE PHOTO DIAGNOSIS

This photo shows corneal lipid deposition in the right eye of a 57-year-old keratoconus patient. He was originally referred for keratitis secondary to chronic inflammation that resulted from an ill-fitting hybrid contact lens. Superior residual lipid deposition and corneal scarring have remained despite resolution of the inflammation.

Keratoconus patients often require specialty contact lenses for improved visual acuity. The inherent corneal irregularity of keratoconic eyes makes them challenging to fit. Contact lenses that are too tight or that have focal areas of bearing can result in inflammation leading to vascularization. These blood vessels can leak lipid deposits into the stroma that persist long-term. Keratoconus patients can be reluctant to discontinue wear of poor-fitting contact lenses, despite discomfort, because of visual dysfunction without the aid of a specialty lens.

This patient was successfully refit into scleral contact lenses after discontinuing the hybrid lenses and treatment with a mild steroid pulsed short-term. The scleral lenses provide successful wear and vison without recurrence of his keratitis. The lipid deposits are a visual reminder of his previous contact lens-related complication.