All successfully fitted patients reported immediate pain relief. The patients' subjective level of discomfort decreased and clarity of vision improved with children becoming more active and not resisting insertion of the eye drops
Naturally, in order to address these issues, a new breed of silicone hydrogel lenses were developed, which allow up to six times more oxygen to pass through them, resulting in better overall eye health. Advantages of these lenses over conventional soft lenses include: more resistance to protein deposits, less drying of the lenses, lower risk of eye infection, easier handling because of increased rigidity of material, and much lower incidence of complications with extended wear (overnight wear). Silicone hydrogel lenses are now widely used for therapeutic purposes, after refractive surgery in adults, however, there is very little information available on the therapeutic use of the lenses in children.
Ocular injury presented as a corneal epithelial defect is always a serious and distressing condition for a child. Surface defects followed by acute pain, discomfort and photophobia effectively disables a child and is often difficult for the family to cope with as the injured child is unlikely to be compliant and the insertion of eye drops can cause even more pain and stress. Patching to protect the ocular surface is one therapeutic option. However, this treatment usually requires hospitalization since parents are often unable to provide the appropriate level of care.
Putting the new generation to the test
A total of 22 patients, requiring therapeutic contact lens wear for ocular surface injury, were enrolled in this prospective, open-ended, non-randomized study. All patients were fitted with Focus Night & Day (CIBA Vision) silicone hydrogel contact lenses (Dk, 140 barrers), base curve 8.6 or 8.4.
Contact lenses were fitted under sedation with 5 mg diazepam delivered by a rectal tube for younger patients. Topical antibiotics, artificial tears and non-steroidal anti-inflammatory drops were used as concomitant treatment. Slit lamp evaluation of contact lens fit and ocular health was performed every morning for the first five days and then once a week, where lenses were worn for longer periods. Indications for the bandage contact lens use included pain relief, corneal protection, enhancement of corneal healing and corneal sealing in cases of corneal wounds.
Twenty two eyes were fitted with a bandage contact lens for corneal conditions caused by trauma: eight eyes for chemical and thermal corneal burns, three for corneal contusions with stromal oedema and epithelial defects, eight eyes for perforating and non-perforating corneal wounds and three eyes for wide corneal erosions. The average age at the time of presentation was 9.3±5.6 years (range, six months to 17.5 years). The mean contact lens wearing time was 7.3±7.8 days (range, one to 30 days).
Changing for the better?
Optimal contact lens fit occurred in 21 of the 22 cases. The lens demonstrated excellent performance on the eye surface with adequate centration and lens movement and was well tolerated by children. Dry eye was the cause of contact lens loss after one day in one eye in the case of chemical injury.