Clinical Case: Management of Corneal Abrasion with Silicone Hydrogel Bandage Lens

Case: PF, a 58-year old Caucasian male, presented with moderate pain in his right eye after being accidentally kicked in the eye by his 2-year old grandson the day before. He complained of sharp pain, tearing, photophobia, redness and blurry vision. He did not report mucous discharge, flashes or floaters, or other ocular symptoms. Entering unaided visual acuities were OD 20/50 PH NI, OS 20/20 (patient did not wear distance correction). Pupils were equal, round, reactive with no APD. Slit lamp examination revealed a 2 x 4 mm epithelial defect with rough, irregular, edematous borders superior-centrally in the right eye. Fluorescein evaluation revealed significant irregularity at the edges of the abrasion, with fluorescein permeating the surrounding epithelium. An infiltrate was not present. The conjunctiva was mildly injected but did not stain. Anterior chamber revealed trace cells. All else, including dilated fundus examination, was unremarkable

PF had a non-infectious, traumatic corneal abrasion with secondary iritis. The superficial corneal abrasion was fairly large, and the patient was moderately uncomfortable. Treatment options included pressure patching, antibiotic ointment, or a bandage contact lens. It has been shown that for non-infected, non-contact lens related traumatic corneal abrasions, treatment with antibiotic ointments and mydriatics alone were superior to pressure patching (1). Also, it has been shown that the use of a bandage contact lens significantly shortens the time to resume normal activities as compared to pressure patching with no difference in healing times (2). Due to the inconvenience to the patient of pressure patching, and the ability of PF to tolerate the pain fairly well, pressure patching was ruled out as a treatment option. However, PF did desire some relief from the pain, so ointment alone was also ruled out. A bandage contact lens with concomitant antibiotic drop administration was decided as treatment for this patient.

Bandage contact lens selection includes FDA approved bandage lenses, such as Focus Night and Day (Ciba Vision Corp.), PureVision (Bausch & Lomb), Protek (Ciba), and the collagen shield. In addition, many other disposable soft contact lenses are used as bandage lenses as off-label usage. Because of the potential for corneal infection with extended wear of a soft bandage lens, high-Dk silicone hydrogel lenses are often selected to minimize hypoxic changes and infection risk. In this case, a Focus Night and Day lens with base curve of 8.4 mm was selected. Prior to lens insertion, a drop of Vigamox (moxifloxacin 0.5%) ophthalmic solution and cyclopentolate 1% were administered. The contact lens was then placed on PF’s eye, and though he noted some discomfort with the lens in place, it was somewhat improved over his initial pain. The lens centered well with about 0.5 mm of blink movement. PF was instructed to use Vigamox tid, keep the lens on the eye, and return the next day.

PF returned the next day with marked improvement in his symptoms. Though the lens still bothered him slightly, he had much less pain, photophobia, redness, and blur. With the lens in place, PF’s visual acuity was OD 20/30. Slit lamp examination revealed that the lens was well-centered with minimal lens movement. The abrasion appeared much improved, with a smaller epithelial defect and less edema. The lens was removed and fluorescein was instilled. A 1x1 mm epithelial defect was observed with mild fluorescein infiltration into the epithelium. Anterior chamber cells were trace. PF noted increased discomfort after the lens was removed, so a drop of Vigamox was instilled and a new bandage lens was placed on the eye. Because it was Friday and because PF had improved significantly in 24 hours, he was instructed to continue bandage contact lens wear and Vigamox use through the weekend, and return on the following Monday. He was also given the optometrist’s cell phone number to use in case the eye became worse over the weekend.

On Monday, PF returned with no symptoms other than mild lens awareness. The lens was removed, relieving PF’s discomfort. His visual acuity had improved to 20/20 OD. Slit lamp examination revealed a completely healed corneal abrasion with no epithelial defect. Bandage lens wear and Vigamox use were discontinued. PF was instructed to return if symptoms recurred.

Silicone hydrogel contact lenses can be useful tools in the management of non-infectious corneal abrasions. Care should be taken if the patient is a soft contact lens wearer, because infection is more likely in this patient group when bandage lenses are worn. However, moderate to large corneal abrasions in non-contact lens wearers can be successfully managed with silicone hydrogel bandage contact lenses, antibiotics, and cycloplegics.

References:

1. Kaiser PK. A comparison of pressure patching versus no patching for corneal abrasions due to trauma or foreign body removal. Corneal Abrasion Patching Study Group. Ophthalmol 1995; 102(12):1936-1942.
2. Donnenfeld ED, Selkin BA, Perry HD, et al. Controlled evaluation of a bandage contact lens and a topical nonsteroidal anti-inflammatory drug in treating traumatic corneal abrasions. Ophthalmol 1995; 102(6):979-984.