Scleral Lens Use in the Management of Ocular Cicatricial Pemphigoid

Purpose: Symptom management in Ocular Cicatricial Pemphigoid (OCP) is challenging because of the progressive factors of dry eye, scarring, trichiasis, and vision impairment. We set out to evaluate the benefits and therapeutic effects of scleral contact lenses in the management of OCP. Methods: A retrospective review was performed over a database of 20 patients (36 eyes) fitted with scleral lenses (SL) at the Department of Ophthalmology, Emory University from May 2018 to April 2021. The fitting indications, time required for ocular surface stabilization, vision rehabilitation success, and ocular complications were evaluated. Results: The mean age was 67.4 (range, 43–81) years, with four to one female to male predominance. The mean duration of the follow-up was 16.5 months (range, 1.5–35). The mean wearing time was 9.0±1.9 hr a day, with no overnight wear permitted. All fitted patients reported a subjective improvement in ocular comfort after initiations of SL wear. The mean keratopathy grading improved from 2.1±0.8 to 1.4±0.7 at the last documented visit. The mean visual acuity improved from 0.56±0.51 (logMAR) to 0.34±0.45; in 46% of patient eyes, visual acuity improved by two or more lines. And 96% of fitted eyes responded well to therapy and continued scleral lens wear. Patients who initially presented with fornix shortening, symblepharon, and trichiasis remained stable. Conclusions: SL offer ocular surface preservation, symptom relief, and improved visual acuity in patients with ocular pemphigoid. They should be strongly considered as ancillary therapy in patients with OCP.