Photoatlus

Cornea1 Dry Area

Joe B. Goldberg, OD, FAA0

Although they once were a fad, contact lenses are ac- ceptable sight vehicles that are worn by multiple millions for daily and extended wear. The success of rigid gas per- meable materials and disposable soft lenses has reduced the incidence and degree of cornea1 interference caused by a poor lens-to-cornea fitting relationship and subsequent in- terference with lacrimal interchange. However, occasion- ally, a clinical situation is presented that is unusual and dictates a need to seek its etiology.

A long-term wearer of an aspheric progressive add rigid gas permeable comeal lens developed scattered cornea1 staining, edema, and a cornea1 dry area (see Figure 1).

Cornea1 staining was more diffuse in the superior cornea1 quadrants on lens removal and there was a dry area between 2 and 4 o’clock (see Figure 2).

For the contralateral eye, there was scattered debris on the lens surface, dry areas under the lens juxtaposed to the bevel and peripheral cornea1 staining (see Figure 3).

Gilbard’ commented that it is a relatively common prob- lem for long-term contact lens wearers of lC-15 years to develop dry eyes. He stated that the probable cause is de-

Figure 1. A cornea1 dry area between 2 and 4 o’clock under a cornea1 lens.

Address reprint requests to Dr. Joe B. Goldberg at 4217 Vir- ginia Beach Blvd., Virginia Beach, VA 23452.

0 1992 Butterworth-Heinemann

Figure 2. Diffuse staining in the superior cornea1 quadrant and a dry area (no fluorescein staining).

Figure 3. Scattered debris on the lens surface and a dry area under the lens juxtaposed to the bevel.

creased cornea1 sensitivity that is cumulative over time and its incidence and degree is greater with cornea1 lenses. This decreases tear secretion and is sufficient to increase tear film osmolarity. Along with decreased sensation, there is decreased secretion.

Reference 1. Gilbard JP: Expert opinion. Contact knr Forum 1989;March: 26.

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