Folded Bandage Contact Lens Retention in A Patient With Bilateral Dry Eye Symptoms

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CASE REPORT REVIEW

Folded bandage contact lens retention in


a patient with bilateral dry eye symptoms

Agung Putra Evasha*

Consultant:
Dr. Ani Ismail, SpM(K)
Source:
DOI 10.1186/s12886-017-0505

MEDICAL STAFF GROUP OF OPHTHALMOLOGY


SRIWIJAYA UNIVERSITY
DR. MOH. HOESIN HOSPITAL PALEMBANG
2020
Introduction
• Bandage contact lenses are commonly used by
ophthalmic practitioners to protect the patient’s
cornea.

• We report a case of folded bandage contact lens


retained for six and a half years in the upper
subtarsal space.

• No other cases of retained bandage contact lens


have previously been described in the literature
AIM to study cases of contact
lens complications where it
is important to have a
thorough eye examination,
and to find out the clinical
suspicion of contact lens
retention.
Case Report
Female, 82 y.o, complaining of foreign body
sensation , with a background of
longstanding dry eye symptoms having
undergone bilateral cataract surgeries a
few months prior

The examining doctor performed a detailed


anterior segment examination and diagnosed
her with bilateral meibomian gland dysfunction.

She was given lid hygiene instructions together


with antibiotic and lubricating eyedrops for a
month.
A year later
• In view of the persistent bilateral ocular pain 
a pair of Precision UV© BCLs were inserted
4 weeks later
• Another ophthalmologist removed the BCL from
her left eye, while none was found in the right
eye.
6 month later
• There were no foreign bodies noted, although
no upper eyelid eversion was documented.
• She was treated for dry eyes.
< 6,5 years after the BCL insertion
• When a nurse practitioner from the eye casualty
unit everted her right upper eyelid and
discovered a ‘foreign body’, noted to be a
folded, discoloured bandage contact lens, which
was removed without difficulty.
Three months later,
• She still struggles with bilateral dry eyes,
despite the daily use of lubricating eyedrops.
Folded, discoloured bandage contact lens hidden behind the
patient’s upper eyelid
Discussion
Discussion
The ‘upper fornix trap’: a ‘trapped’ contact lens within
the upper conjunctival fornix, where the lens’ lower
border is wedged into the upper tarsal edge

There is a possibility of contact lens erosion from


the upper fornix towards subconjunctival space, by
pressure necrosis of the surrounding tissue

Erosion of such foreign bodies into eyelid tissue could


even clinically present as a cyst or chalazion
The lack of clinical
suspicion the
Retained contact bilateral nature of her
lens : missed when ocular complaint and
the clinical picture is
the absence of
masqueraded by
other distracting unilateral symptoms
information which led the
clinicians away from
considering contact
lens retention.
Soft contact lenses may have a higher possibility of
asymptomatic retention than hard lenses .

In our case, we hypothesize that retained soft contact lenses may


also more readily fold into it self spontaneously( blinking
movement)

Its importance of performing a thorough eye examination,


which includes double eversion and sweeping of the fornices
 to reliably rule out the possibility of any retained contact
lenses
Conclusion
Bandage contact lenses (BCLs) are commonly used in ophthalmic
departments to protect the cornea

Larger diameter reduces the


BCLs can be available at larger contact lens’ movement
diameters than modern commonly-
used corrective soft contact lenses
which is important in protecting
a diseased cornea
Conclusions

• The ‘upper fornix trap’, where the contact lens may be


retained by the upper tarsal edge
•↓
• anatomical hazard

• Soft contact lenses may be more likely to retain


asymptomatically and to fold onto itself compared to
hard lenses.
Conclusions

Our case report highlights the importance of eye examination


includes:
- double eversion of the upper eyelids
- sweeping of the fornices with cotton buds
- maintaining clinical suspicion of contact lens retention
Critical Appraisal
Were patient’s demographic charateristics clearly describe?
Yes, in this case report describe about patient’s race

Was the patient’s history clearly described and presented as a


timeline?
Yes, in this case report clearly described about patient’history, but its not
completely describe the timeline

  Was the current clinical condition of the patient on


presentation clearly described?
No, The clinical condition of the patient in this case report was not detailed.
Were diagnostic tests or methods and the results clearly
described?
Yes, diagnostic test and the results clearly described

Was the intervention(s) or treatment procedure(s) clearly


described?
Yes, the treatment and procedure clearly described

  Was the post-intervention clinical condition clearly described?


Yes, post-intervention clinical conditions were described but incompletely
Were adverse events (harms) or unanticipated events
identified and described?
No, the author doesn’t described adverse event can occur and compare from the literature

Does the case report provide takeaway lessons?


Yes, from this case report we can get takeaway lessons about highlight the
importence of perfoming a thorough eye examination which include double
eversion of the upper eyelid and sweeping of the fornices.
THANKS!
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