3-9 STAINING FROM IMPROPER RIGID GAS PERMEABLE CONTACT LENS FIT

Notice the staining at 3:00 and 9:00 on the cornea.  also notice the excessive bearing of the contact lens on the cornea almost 360 degrees in the mid-periphery towards the last contact lens curve. Flattening the center curve can cause excessive bearing on the center.  The simplest solution for me is to put this lens in a scleral lens, but that's not the only solution. 

CONGENITAL HYPERTROPHY OF THE RETINAL PIGMENT EPITHELIUM (CHRPE) WITH LARGE LACUNAE

CENTRAL CORNEAL ULCER

Patients who don't follow their doctor's instructions for wearing their contact lenses are at higher risk of developing infectious corneal ulcers.  If an ulcer is out of the visual axis, a remaining scar will not affect the vision.  But a central ulcer, like this one, is at high risk of developing permanent loss of vision to some degree.  Culturing becomes important in case chosen treatment isn't effective.   In addition to proper antibiotic treatment, the best chance of minimizing the scar is the use of an amniotic membrane and possibly the very judicious use of topical steroids as the infection is controlled. 

SEVERE DRY EYE

This photo demonstrates decreased tear break up time, punctate staining, and corneal filaments associated with severe dry eye.  This patient is a great candidate for a scleral lens. 

MITTENDORF DOT

Mittendorf Dot is a congenital opacity on the posterior capsule of the lens of the eyes.