Gas permeable scleral lenses as a conservative treatment option for extreme corneal ectasias and severe dry eye

Purpose. Due to their exclusive scleral contact zone, non-ventilated gas permeable scleral contact lenses can be used to correct extreme keratectasia, even if corneal fitted contact lenses failed previously. As the gap between the scleral lens and the cornea is filled with fluid substitutes, they also can be used for patients with severe aqueous-deficient dry eyes. Patients, material and method. Scleral lens fitting was attempted in 13 eyes (9 patients, group I) of patients with extreme corneal ectasia and 9 eyes (5 patients, group II) with severe ocular surface disease. Best corrected visual acuity, keratometry, Schirmer's test, foreign body sensation, and total daily lens wearing time were recorded prior to and after scleral lens fitting. Results. Scleral lenses were successfully fitted and used on a long-term basis in 6 of 13 eyes (4 patients) of group I and 4 of 9 eyes of group II. In 9 eyes visual acuity increased by at least 2 lines, but long-term lens wear was not possible due to severe foreign body sensation or fornix shortening. Conclusions. Modern gas permeable scleral lenses can successfully be used for nonsurgical rehabilitation of severe corneal ectasia and dry eyes.