A different (therapeutic) role of contact lens. Useful in corneal epithelium breach.

1. Presented by
Loknath Goswami
B. Optom 3rd year
2015 - 2019
Ridley college of optometry

2. Introduction
• Bandage contact lenses are widely used in refractive
surgery
• The main purpose of this practice is to reduce
inflammatory cell infiltration into the corneal stroma
therefore decreasing the threat of corneal scarring
• Also, bandage lenses assist in the regeneration of
basement membrane and restoration of tight epithelial
stromal adhesion
• The bandage lens protects the loosely adherent and
regenerating epithelium from the relentless action of the
eyelids
• In addition, the lens provides comfort without affecting
the patient’s vision

3. Aim
• The therapeutic lenses principle aim is to
bandage the eye as a therapy which
– Provides relief from pain
– Serves mechanical protection by separating the
epithelial surface from the external agents such as lid
surfaces, thus protecting the epithelium
– Seal corneal perforations by acting as a splint for the
underlying weaker tissues and supports the area while
healing takes place
– Corrects the surface irregularities in irregular corneas
and improves visual acuity

4. Ideal contact lens

5. Conditions of eye which are suitable
for therapeutic lenses
• Eyelids abnormalities –
– Entropion
– Trichiasis
– Ectropion
– Lagophthalmos

6. Conditions of eye which are suitable
for therapeutic lenses
• Ocular surface disorders – chemical injuries,
dry eye, Stevens-Johnson syndrome

7. Conditions of eye which are suitable
for therapeutic lenses
• Corneal surface disorder
– Recurrent erosion syndrome
– Keratitis
– Traumatic epithelium abnormalities
– Filamentary keratitis
– Bullous keratopathy

8. Lens materials for extended wear use
Hydrogels
Silicone
hydrogels
High Dk RGP
lenses
Collagen
Sheilds
Scleral
lenses

9. HYDROGELS—SOFT LENSES
• HEMA lenses used for extended period are a
choice dependent on the corneal pathology.
i. High water content soft lenses:
• Lenses with water content 80% and Plano power are
available as bandage lens.
• They are suitable for epithelial defect patients.
• These lenses act as bandage which necessitate minimal
epithelial disturbance and help in relieving pain

10. HYDROGELS—SOFT LENSES
ii. Mid water content lenses:
– Lenses with 45 to 60% water content may be the
choice for small perforations or leaking wounds.
– They act as a splint.
iii. Low water content lenses:
– Low water (below 45%) thin lenses as bandage
lenses
– Used in disorders of lids such as trichiasis causing
trauma to cornea.

11. SILICONE HYDROGELS
• Silicon hydrogels are new generation lenses.
• They cause significantly lower level of hypoxia
related effects compared to the leading EW
hydrogel lenses.
• They also have lower level of bacterial binding
with them.

12. COLLAGEN SHIELDS
• Their main function is drug delivery.
• Shields soaked in the drug.
• Antibiotics are applied to the eye in case like
bacterial ulcers, post PK, etc. where the drug
is released in high concentration.

13. High Dk RGP
• Rigid lenses are frequently used for a combination
of optical and therapeutic indications.
• All corneal abnormalities leading to irregular
astigmatism or high amounts of astigmatism will
benefit visually only with rigid lenses.
• Conditions like post keratitis cornea, post PK,
traumatic cornea or keratoconus, the cornea is
already compromised so lenses with maximum Dk
should be fitted to these patients to prevent
further insult to the cornea

14. SCLERAL LENSES
• Scleral lenses have a host of therapeutic roles
• Their advantages include the following:
– There need be no corneal contact whatsoever.
– Any eye shape can be fitted.
– Complete protection of the cornea and bulbar
conjunctiva is provided.
– Sealed fits are possible, using gas-permeable
materials, which simplifes the ftting process and
minimizes ‘settling back’.
– Using gas-permeable materials, overnight wear is
possible.

15. SELECTION OF THE LENS
1. Oxygen Transmissibility
– High water content, thin mid water content lenses,
silicone hydrogels or high Dk RGP lenses give the best
transmissibility.
– Lenses which have to be worn for extended periods
should be selected from either of these materials.
– Select high water contact lens in eye conditions where
the lens has to act as a splint.
– RGP lenses are for irregular compromised corneas to
achieve better vision .

16. SELECTION OF THE LENS
2. Diameter
– Soft bandage lenses are usually larger in diameter
usually 14.0 to 15.0 mm.
– Larger diameter lenses (15mm to 20mm) may be
required where the specific function is to protect the
limbus or prevent wound leakage at suture or incision
sites
– Larger diameter lenses require flatter back optic zone
radii to achieve the desired fit.
3. Power
– Bandage lenses are usually plano in power.

17. SELECTION OF THE LENS
4. Disposable Lenses or FRP Lenses
– Disposable lenses or FRP lenses are selected as
bandage lenses.
– Therapeutic lenses should be preferably discarded
after every use.
– They are nowadays rarely cleaned and reinserted.
– Deposits formation is very likely and heavy in such
eye conditions.

18. Use after Refractive Surgery
• Surface Ablation
• Immediately after surface ablation procedures
such as LASEK or PRK, bandage contact lenses
are routinely applied to patients’ eyes to
encourage re-epithelialization and healing,
and to reduce discomfort and pain

19. LASIK
• Bandage contact lenses can be applied after, to
reduce discomfort and prevent epithelial in-growth
• However, some believe this actually increases the risk
for striae, or may not have any beneficial effects
• Some patients are at risk of developing an epithelial
slide, especially those with a history of anterior
basement membrane dystrophy. If an epithelial slide
occurs during the operation, a bandage contact lens
may be applied to the eye to improve healing and
protect the eye until the epithelium has regrown

20. Striae and epithelial in-growth

21. Striae
• Striae, or flap folds, are a complication of LASIK in up
to 3.5% of cases.
• The folds can disturb visual acuity, though often they
resolve on their own.
• Causes of striae include flap dessication, flap
misalignment and flap tenting.
• Striae can be classified as
– macrostriae or
– microstriae
• The treatment for both groups can involve the use of
bandage contact lenses.

22. Macrostriae
• These are caused by flap dislocation and often
involve the entire thickness of the flap. If the
macrostriae are not detected early, the flap
must be refloated and stretched again.
• Different methods have been proposed for
this procedure, but many involve the use of
bandage contact lenses after completion to
help the epithelium re-grow correctly.

23. Microstriae
• These are smaller flap folds that are caused by
problems in flap settling.
• These striae more often resolve on their own
with the help of artificial tears and bandage
contact lenses.
• However, if the striae persist, stretching or
refloating of the flap may be necessary, and a
bandage contact lens is used.

24. Epithelial In-growth
• Epithelial in-growth is an infrequent complication
of LASIK, that is caused either by implantation of
epithelial cells during surgery or from epithelial
cells growing underneath the flap.
• Removal of the in-growth involves lifting the flap,
irrigating the interface and subsequently placing
a bandage contact lens.
• This prevents epithelium from re-entering the
flap interface

25. Overcorrection
• In cases of consecutive hyperopia, also known as
overcorrection, bandage contact lenses may be
used in conjunction with non-steroidal anti-
inflammatory drugs (NSAIDs) to reduce the need
for a second surgery.
• The contact lens helps increase the NSAIDs
penetration into the cornea to stimulate stromal
re-growth.
• The tight fit of the contact lens also creates a
contour that helps correctly shape the growth.

26. Complications
• In some cases, bandage contact lenses can
lead to infectious keratitis.
• Other complications can include
– dry eye,
– corneal hypoxia and
– corneal edema
• Patients should be aware of proper lens
hygiene.

27. Bandage contact lens after photorefractive
keratotomy
• Although there are many conventional
therapeutic soft lenses on the market, disposable
contact lenses have become very popular
bandage lenses.
• The advantages of disposable lenses include less
expense, less risk of corneal infection, and less
risk of toxic complications with concurrent use of
topical medications.
• They are also easy to replace if a contact lens is
accidently dislodged or lost.

28. Bandage contact lens after photorefractive
keratotomy
• Standard hydrophillic disposable lenses (e.g.
Acuvue TM, Vistakon) approved for extended
wear have shown good clinical efficacy, but
silicone hydrogel disposable lenses
(PureVision TM, B&L; or focus Night & Day
TM, CIBAVision) also offer the advantage of
decreasing the risk of hypoxic complications
with continuous wear

29. Bandage contact lens after photorefractive
keratotomy
• Although the risk of infectious keratitis with the
use of therapeutic contact lenses after PRK is low,
bacterial contamination has been found on the
bandage contact lenses after removal.
• Microorganisms found on the lenses typically
represent the bacteria found in the normal ocular
flora, indicating the need for careful monitoring
and follow-up.
• Topical antibiotics combined with no handling of
the lenses by the patient reduce the risk of
bacterial infection

30. Fitting a therapeutic hydrophilic lens after
photorefractive keratotomy
• At the conclusion of the PRK procedure, the
surgeon generally places a disposable contact
lens on the eye. The contact lens should be
chosen based on the preoperative
measurements. The patient should be examined
at the slit lamp approximately 30 minutes later to
determine the contact lens-cornea relationship
• There may be both patient discomfort as well as
interference with reepithelialization. Check to be
sure the contact lens is not inverted before
changing base curves.

31. Fitting a therapeutic hydrophilic lens after
photorefractive keratotomy
• If the contact lenses does not have
movement, the causes may be:
– A steep base curve, which may produce corneal
edema. In this case, try a flatter curve.
– Edema of the conjunctiva produced by the use of
a device such as a suction ring. In this case, the
contact lens should not be disturbed.

32. Fitting a therapeutic hydrophilic lens after
photorefractive keratotomy
• If there is foreign material, rolled epithelial
edges, and/or significant debris under the
contact lens, it should be exchanged.
• On the other hand, if the quantity of debris is
very small, one should avoid disturbing the
lens. Its removal, aside from producing
discomfort, may actually increase the size of
the epithelial defect.

33. Advice to the patient
• Avoid removing the lens at home specially if the
patient have no experience with contact lenses.
Removal will typically be done at an office visit, once
the epithelium is intact. Manipulation of the contact
lenses by the patient can increase the risk of infection
• Avoid environmental pollutants and activities that
significantly reduce the blink rate, which may cause
dehydration of the contact lens. A dry contact lens
produces discomfort, facilitates deposit formation,
diminishes oxygenation of the cornea and increases
the risk of infection.

34. Advice to the patient
• Avoid cosmetic around the eyes until the
contact lens has been removed
• Use lubricants, preferably non-preserved,
between administration other topical
medications in order to lubricate and clean
the contact lens
• Discard the contact lens if it comes out of the
eye

35. Removing the lens
• The following steps are recommended
– Wet the contact lens and wait 2-5 mins before
removing it
– Use a drop of anaesthetic if necessary to reduce
trauma
– Ask the patient to look up
– Pull the contact lens inferiorly and remove it with
fingers or with a fine, non toothed forceps at the
slit lamp

36. FITTING GUIDELINES
• KERATOMETRY
– It is usually not possible to determine the corneal
curvature in such eye conditions.
– The mires are heavily distorted.
– Corneal topography or Keratoscopy can give some
useful information in selecting curvatures.
– In case of traumatic corneas, the good eye K reading
can form a base line to start with, on the assumption
that the corneal curvature may have been same
before trauma in the eye to be fitted with contact
lens.

37. FITTING GUIDELINES
• ANTERIOR SEGMENT ASSESSMENT
– Anterior segment assessment is important.
– Staining if possible should be done with rose Bengal
dye and recorded and graded.
– Also the eye should not be in acute infective state
during fitting.
– Tear film stability should also be measured.
• TYPE OF LENS
– Select the type of lens according to the eye condition

38. For Soft Lenses
• Allow the lens to settle on the eye may be for 15
to 20 minutes - Optimal fit—reasonably well
centered - Complete coverage of the cornea.
• Movement slightly restricted at the same time
does not allow the debris to accumulate
behind.About 0.3 to 0.5 mm with each blink.
• Observe the eye condition after 4 hours, then 24
hours of wear. Ensure there is no complication
developing because of the lens and the wound
has started healing.

39. For Soft Lenses
• In most cases the bandage lens is worn for short
periods of extended wear, regular follow-ups are
important.
• It is the practitioner who inserts and removes
these lenses whenever needed. However, the
patient should also be explained the emergency
removal technique and contact lens care and
maintenance. He should have a container with
the soaking solution at hand with him.

40. For RGP
• Measure the good eyes keratometry in case of
uniocular disorders as base line.
• The fitting is done on hit and trial basis.
• There should not be excessive bearing or
clearing areas.
• The tears should exchange properly and debris
should also not collect behind the lens
• Achieve a stable centered lens.

42. References
• Mark J. Mannis, contact lenses in Ophthalmic
Practice, 1st edition, page no. 148 – 187
• Monica Chaudhry, Contact Lens Primer, 1st
edition, page no. 162 – 173
• Therapeutic Contact lens, Manoj Aryal, B .
Optometry, Institute Of Medicine,
Maharajgunj Medical campus
• http://eyewiki.aao.org/Bandage_Contact_Len
ses_After_Refractive_Surgery

43. Thank you