Limbal Stem Cell Deficiency (Contact Lens-Induced)

Limbal Stem Cell Deficiency (Contact Lens-Induced)
SYMPTOMS Discomfort | Blurry vision | Contact lens-induced LSCD is often asymptomatic
SIGNS Corneal conjunctivalization | Neovascularization | Epithelial keratopathy | Corneal scarring | Curvilinear or whorl-like NaFl pattern
WORK-UP Thorough history. Slit lamp examination with NaFl dye
Discontinue CL wear | Preservative-free artificial tears | Autologous serum drops | Cyclosporine 0.05% 1 gtt OU bid
Topical steroids may be used to manage inflammation: Lotemax 1 gtt OU qid | Pred Forte 1% 1 gtt OU qid
Limbal graft transplantation may be indicated in severe cases
FOLLOW-UP Every few days during treatment
Contact lens-induced LSCD stems from contact lens wear (extended wear, overnight wear, etc.) and is thought to be a multifactorial process | Trauma/friction, hypoxia, inflammation, dry eye and other factors may contribute to the development of contact lens-induced LSCD
DIFFERENTIAL DX Conjunctival/corneal intraepithelial neoplasia | Superior limbic keratoconjunctivitis | Epithelial basement membrane dystrophy
NOTES LSCD may be caused not only from soft contact lenses but from rigid lenses or improperly fit scleral devices as well