Management of focal limbal stem cell deficiency associated with soft contact lens wear.

PURPOSE

To present the varying manifestations of and the treatment methods for corneal epitheliopathies because of focal limbal stem cell deficiency (LSCD) associated with soft contact lens (SCL) wear.

METHODS

The medical records of patients seen at 3 institutions who developed focal LSCD, based on clinical examination, that was attributed to SCL wear were reviewed. Information regarding the patients' demographics, contact lens wearing schedules, medical and surgical treatment modalities, and clinical and visual outcomes were recorded.

RESULTS

Eighteen eyes of 10 SCL wearers were found to have varying degrees of corneal epitheliopathy secondary to focal LSCD. Nine of the 10 patients (90%) were women, and the mean age of all patients was 35.1 years (range, 20-58 years). The mean duration of SCL wear was 15.2 years (range, 4-30 years). Two patients wore the lenses for 20 hours per day. Mean follow-up time was 7.0 months (range, 0.25-24 months). Visual acuity at first examination was affected in 10 of the 18 eyes (55.6%) and ranged from 20/30 to hand motions. The focal LSCD was found superiorly in all involved eyes and inferiorly in only 5 of 18 eyes (27.8%). The epitheliopathy resolved or stabilized in 11 eyes (61.1%) with cessation of SCL wear and use of artificial tears. Five eyes required topical corticosteroid eyedrops, and 2 eyes required surgical intervention. One eye had a best spectacle-corrected visual acuity of less than 20/30 at last follow-up.

CONCLUSIONS

Focal LSCD can be a result of SCL wear, presenting with varying manifestations. SCL wearers should be monitored routinely and counseled on this possible complication. Early identification of focal LSCD in SCL wearers with subsequent cessation of wear may prevent the need for surgical intervention.