Special contact for DRY EYES

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Mike Bartolatz
Posts: 6595
Joined: Fri Feb 06, 2004 9:58 pm

Special contact for DRY EYES

Post by Mike Bartolatz »

Special contacts for dry eyes
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Although the topic of the following exchange between two doctors is concerning dry eyes associated with Stevens Johnson Syndrome (referred to as SJS) it might prove informative and beneficial to our members here.

wish all the very best,
Mike Bartolatz

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Thread: Stevens Johnson Contact fitting
Irenesang

Total Posts: 1
Location: Pasadena, CA
Posted Tuesday, March 23, 2004 01:03:04 PM
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Hello! I have been referred a patient by a local university based ophthalmology center for a contact lens fit. She wears a prosthetic in her right eye, and has a severely scarred, irregular cornea in the left eye from Stevens Johnson Syndrome. She is also aphakic, and cannot tolerate spectacle lenses. She is currently FC@ 5 feet, and can achieve FC@ 8 feet with a trial contact lens. She likes the improvement, and I am currently in the process of fitting her with a large corneoscleral (18.0 mm) contact lens. She will have difficulty seeing and cleaning the lens, and I would like to know if extended wear would be a reasonable consideration for her. The contact lens will provide a constant, sealed saline bath for her entire cornea, which may improve comfort sigficantly. She currently uses lub. gtts. q 1-2h. However, since she is monocular, I am concerned about the infection risk. I believe there is little chance an infection would worsen her vision as the cornea is so very opaque and irregular. Are long term Stevens Johnson patients with thick, dry corneas any more or less at risk for serious infection? Would you allow extended wear for her given that she is legally blind and lives only with her 7 year old daughter? Thanks so much for your advice!!
csf

Total Posts: 147
Posted Tuesday, March 23, 2004 04:13:12 PM
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Several points:
1. SJS patients (or for that matter, anyone with a dry, debilitated ocular surface) is a sitting duck for infection of the ocular surface, and extended lens wear adds to that risk.
2. Gas permeable scleral lenses of the type which are custom fit from taking a mold have been and continue to be a God-send for many patients with the consequences of SJS which you describe. I know of only one place where these lenses can be fitted and made, and that is by Dr. Perry Rosenthal, in Chestnut Hill, MA. I suggest you consider visiting the following web site for more information on this device, which revolutionized my care of patients with SJS a decade ago. www.bostonsight.org.
3. Visual rehabilitation of super dry, scarred eyes is more possible now than a decade ago through keratoprosthesis, and especially through the Dohlman keratoprosthesis. If this patient were to travel to Massachusetts in order to pursue the scleral lens matter, it would make, in my opinion, enoumous sense for the patient to also have a consultation with Professor Claes Dohlman, at the Massachusetts Eye and Ear Infirmary, in order to explore the (remote) possibility that keratoprosthesis would be a reasonable additional option to consider in an effort to get considerably better eye sight.

Sincerely,

C. Stephen Foster, M.D.
Mike Bartolatz
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