Case study: Scleral lens manangement

In the first article in this series (click here) we looked at the full assessment and management of a patient presenting with symptoms of ocular discomfort likely associated with ocular surface compromise. After some intervention, the patient presented at the three-month review with improved signs including resolution of the inferior corneal staining, improved meibomian gland expressibility and quality, massively improved NIBUT and TBUT (see figure 1), improvement in tear volume measurements and consistently low conjunctival hyperaemia (figure 2). Table 1 summarises the clinical findings at this visit.

The patient reports good compliance and noticed an overall improvement in her symptoms (mirrored by slightly improved Speed index score). However, the symptoms of photosensivity during VDU work and the pain in and around her eye remain and are therefore still causing her quite some concern. The Speed index score, although improved, is still very high.