Transient corneal epithelial bullae associated with large diameter scleral lens wear: A case series. Issue 5 (October 2018) - Isozaki, Veronica L.
Graphical abstract: Highlights: Anterior segment OCT imaging is useful for viewing epithelial bullae with scleral lenses on the eye. Epithelial bullae can be appreciated within the scleral lens fluid chamber but quickly flatten after lens removal. Separation of the corneal layers appears to occur at the basement membrane of the epithelium. Epithelial bullae do not appear to reoccur when scleral lens wear is discontinued and corneal health has improved. Abstract: With the increased fitting of scleral lenses by eye care practitioners, complications with lens wear need to be considered. Several prior studies have addressed complications specific to scleral lens wear and the incidence of hypoxia with extended wear, but few report the presence of epithelial bullae. This case series investigates three patients with differing ocular surface diseases, yet all developed transient epithelial bullae with concurrent large diameter scleral lens wear. These bullae appear to form due to weakened connections in the corneal epithelium at the level of basement membrane and Bowman's layer and flatten within minutes of lens removal. These bullae need to be further studied, as they can increase the patient's risk of epithelial defects, infections, and other complications in already compromised corneas.