Occluder Prosthetic Soft Lens for Diplopia Management in Adult Strabismus

Overview

A 51-year-old female with myasthenia gravis and secondary strabismus experienced intermittent diplopia managed successfully with a computer-generated occluder prosthetic soft lens. The lens provided immediate relief and satisfactory cosmetic appearance while maintaining comfort.

Background

Soft prosthetic lenses are commonly used for cosmetic improvement in anterior segment disfigurement but can also serve therapeutic roles such as managing diplopia in adult strabismus. Diplopia due to strabismus can significantly impair quality of life, and occlusive lenses offer a non-surgical option for symptom relief. This case highlights the fitting process and clinical considerations for such lenses in a patient with myasthenia gravis-induced strabismus.

Data Highlights

The patient had 20/20 visual acuity in both eyes with a constant >30 prism diopter left esotropia. The trial lens was 14.5 mm diameter with an 8.6 mm base curve and an 11.5 mm prosthetic iris size, which was slightly insufficient. The final lens had a 12 mm prosthetic coverage, 38% water content, Dk of 9, black backing, and a closed pupil design.

Key Findings

• The patient had intermittent diplopia secondary to myasthenia gravis-induced left esotropia.
• Initial trial lens with 11.5 mm prosthetic coverage was inadequate; a 12 mm coverage was required for full iris occlusion.
• Computer-generated prosthetic soft lenses allowed precise color matching and reproducible fitting.
• The final occluder lens provided immediate diplopia relief and was cosmetically acceptable.
• Low oxygen permeability (Dk 9) and pigment presence necessitate monitoring for hypoxia-related complications.
• Hydrogen peroxide care system and annual lens replacement were recommended for maintenance.

Clinical Implications

Occluder prosthetic soft lenses are a viable non-surgical option for managing diplopia in adult strabismus, especially when patients seek cosmetic and functional improvement. Careful measurement and fitting are essential to ensure adequate iris coverage and comfort. Clinicians should monitor for hypoxia due to low oxygen permeability of pigmented lenses and educate patients on appropriate lens care and replacement schedules.

Conclusion

Computer-generated occluder prosthetic soft lenses can effectively relieve diplopia in adult strabismus with good cosmetic outcomes, offering an alternative to surgery. Ongoing monitoring is important to prevent hypoxia-related complications.

References

1. DeNaeyer GW 2024 -- Contact Lens Case Reports: Occluder Prosthetic Soft Lens to Manage Diplopia