The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India.
Bausch and Lomb Contact Lens Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India.
BMJ Case Rep. 2022 Jul 5;15(7):e248384. doi: 10.1136/bcr-2021-248384.
Chemical injuries can severely damage the ocular surface. We present the case of a man in his 40s with severe periocular chemical injury with total lid loss and severe exposure keratopathy. He sustained burns to 45% of his body surface area and needed tracheostomy and multiple full-thickness skin grafts. Both eyes required surgery, Boston type 1 keratoprosthesis and penetrating keratoplasty for the right and left eye, respectively. There was melting in the right eye and a persistent epithelial defect in the left eye. Eventually, we suggested 18 mm diameter scleral contact lenses for both eyes to aid in ocular surface stabilisation. His best corrected visual acuity improved significantly with the scleral lenses to 20/100 and 20/320 in the right and left eyes, respectively. This case demonstrates that scleral lenses can treat the complications of exposure keratopathy and can improve vision. Therefore, they may be considered for rehabilitation of the ocular surface in eyes with severe chemical periocular injuries.
化学性眼外伤可严重损害眼表。我们报告 1 例 40 多岁男性，发生严重的眶周化学性烧伤，导致全眼睑缺损和严重暴露性角膜炎。患者烧伤面积达 45%，需要行气管切开术和多次全层皮肤移植。双眼均需手术治疗，右眼行 Boston 1 型角膜热成形术，左眼行穿透性角膜移植术。右眼发生融解，左眼持续存在上皮缺损。最终，我们建议为双眼佩戴直径 18mm 的巩膜接触镜，以帮助稳定眼表。右眼和左眼的最佳矫正视力分别显著提高至 20/100 和 20/320。本病例表明巩膜镜可治疗暴露性角膜炎的并发症，并提高视力。因此，对于严重眶周化学性烧伤的眼，可考虑使用巩膜镜来康复眼表。
