Download Crystal Meyer OD Cornea and Contact Lens Resident New England

Crystal Meyer OD
Cornea and Contact Lens Resident
New England College of Optometry
8/31/2012
Case Report: Scleral Contact Lens as an Option for a Corneal Keloid Scar
ABSTRACT
67 yo male with history of keloid formation and ocular trauma developed a hypertrophic elevated
corneal scar that reoccurred after surgical removal. Spectacle BCVA was 20/400 but a scleral contact
lens improved BCVA to 20/25.
OUTLINE
I. Case History:
-Patient demographics: 67 year old white male
-Chief complaint: Referred for a contact lens fit due to poor vision OD with current glasses since
ocular trauma resulting in a corneal scar that reoccurred after surgical removal.
-Ocular: OD Vegetative non perforating ocular trauma (2 years ago), slow healing epithelial
defect with associated dellen formation, ultimately ending in presumed keloid scar formation.
-Medical History: Hypertension, Arthritis, Depression
-Medications: Restasis, Celebrex, Diclofenac, Avapro, Bystolic, Fish oil, Venlafaxil, and Flaxseed
oil
-Other salient information: Patient burned 95% of his body in 1984 in a gas tank explosion
causing keloid scarring covering most of his body.
II. Pertinent findings
-Physical: Anterior segment findings: dense elevated avascular central corneal scar just below
the visual axis OD, SPK OU, Additional anterior segment examination WNL
-Laboratory studies: Topography: Dense steepening centrally and irregular astigmatism
-Others: SIM-K readings OD 41.70/45.91@ 114; OS 43.06/43.49@ 30
BCVA with glasses OD 20/400 and OS 20/20-1
III. Differential diagnosis
-Primary/leading: Presumed corneal keloid scar
-Others: Severe dry eye
IV. Diagnosis and discussion
-Elaborate on the condition: It is unclear if the lesion is a corneal keloid scar (without
microscopy) but its recurring nature, large size compared to the original injury and patient
history of a previous keloid scarring suggest the possibility. Corneal keloid scars are rare with
only 70 cases reported in the past 6 decades (1). While there is some debate as to whether or
not keloid scars are different than hypertrophic scars, there seems to be a trend that keloid
scars are more likely to recur after treatment (2). In conjunction with failed previous efforts of
removal, poor vision with glasses due to the irregularity of the cornea and the patient’s history
of severe dry eye, a scleral contact lens may be the best possible solution.
-Expound on unique features: reoccurring nature and the possibility of the scar increasing in
size may eventually impede on the patients visual axis
V. Treatment, management
-Treatment and response to treatment: MSD scleral contact lens with OD BCVA 20/25, with
excellent comfort and improving dryness and SPK. The patient will continue to wear progressive
eye glasses over the contact lens.
VI. Conclusion
-Clinical pearls, take away points if indicated: Consider scleral contact lenses in patients where
keloid corneal scar or hypertrophic scars distort the cornea but still may allow for excellent
vision and comfort.
References
(1) Corneal Keloid: Clinical, ultrasonographic and ultrastructural characteristics Jcataract Refract
surg, 2004 Apr 30 (4) pgs 921-4
(2) Keloids a review of the literature, BR J plast surg 1990 Jan;43 (1) pgs 70-7
(3) Clinical, surgical and histopathologic characteristics of corneal keloid, Corrnea 2001; 20:421-424
(4) Hypertrophic or keloid scars? EYE 1994: 8; 200-3