Conjunctival prolapse during open eye scleral lens wear

To investigate the incidence and peak elevation of conjunctival prolapse during short-term open eye scleral lens wear and its association with lens fitting characteristics.

Ten young, healthy adults (mean age ± SD, 30 ± 4 years) wore a high Dk sealed scleral lens for 90 min with an initial central post-lens fluid reservoir thickness defined as low (144 ± 23 μm), medium (487 ± 63 μm), and high (726 ± 55 μm). Optical coherence tomography was used to quantify limbal clearance, lens settling, and changes in conjunctival thickness.

The incidence of conjunctival prolapse was 37% across all fluid reservoir thickness conditions, with 80% of participants exhibiting conjunctival prolapse at least once. Prolapse was observed more frequently nasally (73%) than temporally (27%) (p < 0.01). The peak prolapse elevation did not vary with fluid reservoir thickness condition or anatomical location (both p > 0.05). For the low fluid reservoir thickness condition, eyes with conjunctival prolapse had greater initial limbal clearance (97 ± 38 μm compared to 43 ± 34 μm, p = 0.01) and more settling after 90 min of lens wear (-85 ± 30 μm compared to -34 ± 29 μm, p < 0.01). Greater limbal settling was associated with a higher peak elevation of the conjunctival prolapse (r = 0.48, p = 0.02), but not with landing zone tissue compression (r = 0.22, p = 0.33) or the initial or final limbal fluid reservoir thickness asymmetry (r ≤ 0.07, p > 0.05).

Conjunctival prolapse was commonly observed during short-term sealed scleral lens wear in healthy eyes. The peak elevation of the conjunctival prolapse was associated with the extent of limbal settling, but not landing zone tissue compression or fluid reservoir thickness asymmetry.