Case report: Utilization of a scleral lens to mitigate exposure keratopathy and associated mental health decline

Purpose: To report a case of acute exposure keratopathy with comorbid depression and improvement of both conditions with the use of a scleral lens (SL).Observations: A 72-year-old male with a past ocular history significant for extensive basal cell carcinoma (BCC) excision of the right upper and lower eyelids presented for evaluation of exposure keratitis and consideration of a SL for the right eye. Examination was notable for post-surgical irregular lid margins with lagophthalmos, trichiasis and an Oxford Grade I staining of the central exposed cornea. Medical history was notable for chronic severe depression and anxiety with suicidal ideation. Upon treatment with a SL, the patient noted ocular comfort, and reported significantly improved affect.Conclusion and importance: Currently, there is no peer reviewed literature reporting on the management of exposure keratopathy in the setting of comorbid affective disorders. This case highlights the improvement in quality of life for a patient with exposure keratitis and severe depression with suicidal ideation and points to the potential utilization of a SL to mitigate the risk of mental health decompensation.