Sjogren’s Patient Fit Into Scleral Lenses

Sjogren’s syndrome is an autoimmune condition that attacks the body’s moisture-producing glands, often causing extreme dry eye that can be difficult to manage with drops alone. For patients in Las Vegas living with Sjogren’s-related dry eye, scleral contact lenses can provide lasting comfort and improved vision by creating a protective, hydrating layer over the cornea.

This case highlights how a patient with both ocular cicatricial pemphigoid and Sjogren’s syndrome was successfully fit into custom scleral lenses at our practice.

What Brought This Patient In?

A 47-year-old female was referred for a specialty contact lens evaluation. She had been diagnosed with both ocular cicatricial pemphigoid and Sjogren’s syndrome. Together, these two conditions cause the eyes to become severely red, irritated, and chronically dry. She was experiencing extreme dry eye symptoms that significantly affected her daily quality of life.

Her existing scleral lenses were approximately two years old. She reported that the lenses were becoming increasingly dirty and prone to fogging throughout the day. She also noticed poor night vision with glare and halos. For rewetting, she had been using only preservative-free sodium chloride solution.

What Did the Examination Reveal?

With her current lenses in place, her vision measured 20/40 in both the right and left eyes. Examination of the lens surfaces revealed a poor wetting surface with visible protein deposits, which contributed to the fogging she described.

Both eyes showed poor tear film stability and inflamed bulbar conjunctiva. Additionally, symblepharon formation was noted in both eyes. Symblepharon is a condition where the inner surface of the eyelid begins to adhere to the white part of the eye. This can develop in patients with severe, chronic dry eye and autoimmune ocular surface disease, and it may worsen over time without proper management.

Why Was a Custom Scleral Lens Chosen?

Given her complex ocular surface conditions and the poor performance of her aging lenses, a custom Latitude scleral lens was selected to provide the best combination of comfort and vision. The Latitude is a custom scleral lens designed using advanced 3D imaging technology.

During the imaging process, the patient looks straight ahead, then up, then down while the instrument captures detailed 3D images of the eye in each gaze position. Software then combines these images to create a comprehensive map of the corneal and scleral surface. This gives the laboratory an exceptional amount of data to design and fabricate a truly customized scleral lens that matches the patient’s unique anatomy.

Our doctors worked closely with the lab to fine-tune the lens design for this patient’s specific needs.

How Did the New Lenses Perform?

When the new custom scleral lenses were dispensed, the patient reported immediate improvement in both comfort and visual clarity. The updated lens surfaces provided a much better wetting surface, reducing the fogging and deposit issues she had experienced with her old lenses.

Managing Dry Eye Alongside Scleral Lenses

Because of the instability of her tear film, additional dry eye treatment was incorporated into her care plan. She was started on Cequa, a prescription eye drop designed to help increase tear production in patients with dry eye disease. She was also advised to replace her sodium chloride solution with preservative-free artificial tears, which contain additional lubricating agents that better support the ocular surface.

This combined approach of custom scleral lenses plus targeted dry eye therapy addresses both the vision and comfort challenges that Sjogren’s patients commonly face.

Key Takeaways for Sjogren’s and Dry Eye Patients

• Scleral lenses create a fluid reservoir over the cornea that provides continuous hydration, making them an excellent option for autoimmune dry eye conditions.
• Older scleral lenses can develop surface deposits and wetting problems over time, so regular follow-up and timely lens replacement are important.
• Custom 3D-mapped scleral lenses offer a more precise fit than standard designs, especially for patients with complex ocular surface disease.
• Dry eye management often works best as a multi-layered approach combining scleral lenses, prescription drops, and proper rewetting solutions.
• If you experience worsening redness, pain, or sudden vision changes, contact your eye doctor promptly, as these may indicate a flare-up or complication that requires immediate attention.

At Insight Vision Optometry, Las Vegas, Dr. Stephanie Woo, OD, FAAO, FSLS, Dr. Nathan Schramm, OD, FSLS, FBCLA, and Dr. Thanh Mai, OD, FSLS specialize in fitting custom scleral lenses for patients with Sjogren’s syndrome, ocular cicatricial pemphigoid, and other complex dry eye conditions. Call 702-747-4070 or visit www.insightvisionlv.com to schedule your consultation.