![]() ![]() In recent years, with the advent of more gas-permeable contact lens materials, scleral shells have become a mainstay in managing this subset of patients who present with severe ocular surface disease. Ocular surface disease is a multifactorial disease, and the addition of cranial nerve palsies requires the practitioner to become innovative with nontraditional approaches. The patient was to continue with the current lens modality and was instructed to follow up in 4 months for further corneal evaluation. Visual acuity improved to 20/60 with complete resolution of monocular diplopia. Slit-lamp examination revealed stable 3-o’clock stromal vessels and 3-o’clock stromal scar, and his punctate keratitis had resolved. The patient increased his lens wear time to waking hours while continuing to use the moisture chamber and antibiotic ointment at night. The area of clearance was filled with preservative-free saline solution (Figures 1 and 2), and the patient was instructed to wear the lens for 4 hours with gradual build-up to waking hours while continuing with the bacitracin ointment and moisture chamber at bedtime.įigure 2 | After approximately two doses of tocilizumab, central foveal thickness was 283 µm.Īt the patient’s 8-week follow-up visit, he reported an improvement in ocular hyperemia and vision. A Zenlens scleral lens (Bausch + Lomb) was fitted to tangentially align the sclera and provide 250 µm of clearance over the cornea and limbus. Slit-lamp examination of the left eye revealed conjunctival injection, central corneal scar, temporal neovascularization, and 2+ punctate keratitis. The patient had tried conservative therapy including tarsorrhaphy, gold weight implantation, aggressive corneal lubrication with preservative-free artificial tears and ointment, and a moisture chamber at bedtime without significant improvement. No pain was noted due to lack of sensation on the left side of the patient’s face. The left facial nerve palsy was secondary to a complicated acoustic neuroma excision performed 3 years prior. The patient history includes total left facial nerve palsy resulting in paralytic lagophthalmos and complaints of worsening vision, eye redness, and double vision due to exposure keratoconjunctivitis. WaveLight ® Excimer Laser Systems Important Product InformationĪ 37-year-old man was referred to our clinic for progressive corneal neovascularization and scarring in his left eye with symptomatic monocular diplopia. How Testing for the Topography-guided CONTOURA Procedure Fits the Diagnostic Environment and Aids Patient Flow Selecting Candidates for CONTOURA Vision, Topography-Guided LASIKĮndorsing CONTOURA Vision, Topography-Guided LASIK Scleral Contact Lenses for Neurotrophic KeratopathyĪdding CONTOURA Vision, Topography-Guided LASIK to the Refractive Armamentarium Intracameral Endophthalmitis Prophylaxis: Where We Stand Proposed Guideline Raises Concerns About Cataract Anesthesia Coverage ![]()
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