Improvement of Vision and Ocular Surface Symptoms With a Scleral Lens After Microbial Keratitis

A 38-year-old woman, previous daily disposable soft contact lens wearer, reported an episode of microbial keratitis positive for Pseudomonas aeruginosa 11 months before contacting the investigators. After acute treatment, she was left with a degree of opacity in the pupillary area, corneal scar, and an irregular corneal profile, with a best spectacle visual acuity of +0.48 logarithm of the minimum angle of resolution. A scleral lens was able to mask those corneal sequelae and, even considering the corneal opacity, the visual acuity recovered to +0.06 logarithm of the minimum angle of resolution. The patient was fitted with a 16.4-mm scleral lens and attended several appointments over a 12-month follow-up period. After 12 months of scleral lens wear, the improvement of both high-contrast and low-contrast visual acuities remained stable and a clearing of the corneal opacity was observed. The comfort was assessed with the Ocular Surface Disease Index questionnaire, which depicted a comfort enhancement from 75.0 to 47.9 over the short term. The Quality of Vision questionnaire was also administrated and showed an improvement on frequency, severity, and bothersome of the vision-related symptoms over time. Scleral lens may be a good option to improve vision, comfort, and restore the ocular surface function in patients with corneal scars and opacities secondary to microbial keratitis.