Clinical Scorecard: Online Photo Diagnosis: Dimple Veiling in Corneal GP Lens Wear
At a Glance
| Category | Detail |
|---|---|
| Condition | Dimple veiling caused by small air bubbles under corneal GP lenses |
| Key Mechanisms | Small air bubbles indent the cornea under the lens, allowing sodium fluorescein pooling and hyperfluorescent circular spots |
| Target Population | Patients with corneal gas permeable (GP) lens wear, especially those with high myopia or irregular corneas |
| Care Setting | Contact lens follow-up and corneal evaluation in ophthalmology or optometry clinics |
Key Highlights
- Dimple veiling appears as discrete, bright, circular hyperfluorescent areas on corneal staining with sodium fluorescein.
- It can be differentiated from punctate epithelial erosion (PEE) by its brighter, more circular appearance and association with air bubbles under the lens.
- Large amounts of dimple veiling or a large air bubble may indicate a steep fitting lens relationship requiring lens refitting.
Guideline-Based Recommendations
Diagnosis
- Evaluate corneal staining patterns after lens removal using sodium fluorescein.
- Identify small air bubbles under the lens corresponding to hyperfluorescent spots (dimple veiling).
- Differentiate dimple veiling from punctate epithelial erosion by brightness, shape, and presence of air bubbles.
Management
- Discontinue lens wear for several minutes to hours to allow resolution of dimple veiling.
- Order new lenses to improve fit if large air bubbles or steep fitting relationships are present.
- Consider adding fenestrations to the corneal GP lens to reduce dimple veiling.
Monitoring & Follow-up
- Monitor visual acuity to assess impact of dimple veiling.
- Reassess corneal staining and lens fit during follow-up visits.
Risks
- Excessive clearance of corneal GP lenses can increase dimple veiling.
- Large amounts of dimple veiling may reduce vision.
- Steep fitting lenses may predispose to dimple veiling, especially in irregular corneas.
Patient & Prescribing Data
Patients with high myopia using corneal GP lenses
Improving lens fit or adding fenestrations can reduce dimple veiling without impacting visual acuity.
Clinical Best Practices
- Carefully assess corneal staining patterns to distinguish dimple veiling from pathological epithelial damage.
- Adjust corneal GP lens fit to avoid steep fitting and excessive clearance.
- Educate patients that small dimple veiling is not concerning if vision is unaffected and resolves with lens discontinuation.
References
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