Therapeutic Contact Lenses in the Treatment of Corneal and Ocular Surface Diseases—A Review : The Asia-Pacific Journal of Ophthalmology

Secondary Logo

Journal Logo

Review Article

Therapeutic Contact Lenses in the Treatment of Corneal and Ocular Surface Diseases—A Review

Lim, Li FRCS(Ed), FAMS(S’pore); Lim, Elizabeth Wen Ling MBBS

Author Information
Asia-Pacific Journal of Ophthalmology 9(6):p 524-532, November-December 2020. | DOI: 10.1097/APO.0000000000000331
  • Open


Therapeutic contact lenses (TCLs) are often used in the management of a wide variety of corneal and ocular surface diseases (OSDs). Indications of TCL include pain relief, enhancing corneal healing, corneal sealing, corneal protection, and drug delivery. For painful corneal diseases such as bullous keratopathy, epidermolysis bullosa, and epithelial abrasions/erosions, bandage contact lenses (BCLs) provide symptomatic relief. Postoperatively in photorefractive keratectomy or laser epithelial keratomileusis, BCLs also alleviate pain. In severe OSDs such as severe dry eye, Stevens-Johnson syndrome/toxic epidermal necrolysis, gas-permeable scleral contact lenses are often used to enhance corneal healing. BCLs are used post-keratoplasty, post-trabeculectomy, and post–amniotic membrane transplantation to enhance healing. BCLs, with or without glue adhesives, are used to seal small corneal perforations and sometimes also used as bridging treatment before penetrating keratoplasty in larger corneal perforations. In patients with eyelid conditions such as trichiasis, ptosis, and tarsal scarring, BCLs are also effective in forming a mechanical barrier to protect the cornea. A relatively new use for TCLs is in ocular drug delivery where TCLs are used to maintain therapeutic concentrations of medication on the ocular surface. Contraindications of the use of TCLs include infective keratitis, corneal anesthesia, and significant exposure keratopathy with inadequate eyelid position or movement. Complications of TCL include infective keratitis, corneal hypoxia and associated complications, corneal allergies and inflammation, and poor lens fit. Overall, TCLs are effective in the treatment of corneal and OSDs but contraindications and complications must be considered.

Contact lenses play an important role in the therapeutic management of corneal and ocular surface diseases (OSDs). The types of contact lenses used for therapeutic purposes include soft lenses and scleral lenses. They exert therapeutic benefit by forming a mechanical barrier between the cornea and the external environment, hydrating the corneal epithelium, increasing corneal wound healing, and providing pain relief. Therapeutic lenses are used to manage a wide variety of corneal conditions including bullous keratopathy, corneal erosions, corneal epithelial defects, and postsurgical conditions such as post-keratoplasty and post–laser vision correction.

OSD is an umbrella term encompassing a wide variety of conditions affecting the ocular surface. These conditions include dry eye disease, blepharitis, meibomian gland dysfunction, and immunologic disorders. Current conservative management options for OSD include artificial tears, topical antihistamines, steroids and immunologics,1 and therapeutic contact lens (TCL) usage.

The purpose of this review article is to evaluate the indications, contraindications, complications, and fitting principles of contact lenses in the treatment of corneal and OSDs.


There are many indications for the use of TCLs in corneal and OSDs. In this article, the indications are divided into 5 broad categories: pain relief, enhancing corneal healing, corneal sealing, corneal protection, and drug delivery (Table 1).

TABLE 1 - Indications of Therapeutic Contact Lenses
Pain Relief Enhance Corneal Healing Corneal Protection Corneal Sealing Drug Delivery
Bullous keratopathyEpithelial abrasions/erosionsPost–laser vision correction: PRK/PTK/LASEK/LASIK Chronic epithelial defects/ulcersHerpes simplex metaherpetic ulcerNeurotrophic keratitisChemical burnsDescemetoceleFilamentary keratitis (Fig. 1B)Dry eyesPost-keratoplastyPost–amniotic membrane transplantPost-trabeculectomy EntropionTrichiasisTarsal scarringRecurrent corneal erosionsPtosis Corneal perforations Ocular surface drug delivery
LASEK indicates laser epithelial keratomileusis; LASIK, laser-assisted in-situ keratomileusis; PRK, photorefractive keratectomy; PTK, phototherapeutic keratectomy.

Pain Relief

In painful conditions such as bullous keratopathy (Fig. 1A), epidermolysis bullosa, and epithelial abrasions/erosions, bandage contact lenses (BCLs) are commonly used to provide pain relief.2–5 For recurrent corneal erosions, a randomized controlled trial showed that although the use of BCLs may not increase the likelihood of complete resolution when compared with ocular lubrication, some patients may experience earlier relief from symptoms.6

Indications for therapeutic lens wear. A, Painful bullous keratopathy. B, Cobalt blue filter image with fluorescein dye showing filamentary keratitis in severe dry eye disease secondary to rheumatoid arthritis. C, Post-DSAEK surgery day 1 showing the DSAEK graft well adhered to the cornea with 30% of anterior chamber air fill and bandage lens wear (corneal epithelium was debrided hence bandage lens was used). D, Bandage lens wear for post–amniotic membrane transplantation for chronic epithelial defect following acanthamoebal keratitis. DSAEK indicates descemet membrane stripping automated endothelial keratoplasty.

BCLs are also used postoperatively to aid in pain relief. After refractive surgery procedures such as photorefractive keratectomy (PRK) or laser epithelial keratomileusis (LASEK), it is standard practice to place a bandage lens for better pain relief.7 A prospective randomized controlled contralateral eye study showed that wearing soft contact lenses had significant and clinically meaningful beneficial effects in visual recovery, pain perception, and reduced haze formation post-PRK as compared with no contact lens wear.8 Silicone-hydrogel (SiHy) contact lenses have been shown to be more significant in reducing subjective pain responses as compared with non-SiHy contact lenses post-LASEK.9 A review article by Sanchez-Gonzalez et al10 summarized several studies comparing the efficacy of different kinds of SiHy contact lenses in pain relief and aiding corneal reepithelialization. In the 13 articles reviewed, 8 SiHy lenses were compared (Asmofilcon A, Balafilcon A, Comfilcon A, Etafilcon A, Lotrafilcon A, Lotrafilcon B, Omafilcon A, and Senofilcon A).8,11–22 Of all materials compared, Senofilcon A had the lowest pain scores and Lotrafilcon A had the fastest epithelial healing post-PRK.10 A subsequent comparative study between Samfilcon A and Lotrafilcon B SiHy contact lenses showed that Samfilcon A lenses were superior in reducing postoperative pain and accelerating re-epithelialization.23 Additionally, soft contact lenses have also been shown to be successful in reducing postoperative pain after autograft pterygium surgery.24 Although the use of BCLs in laser-assisted in-situ keratomileusis (LASIK) is not widespread and currently depends on surgeon preference, a prospective randomized clinical trial showed that patients felt less discomfort and had a less intense wound healing response in eyes with BCLs as compared with control eyes post–femtosecond LASIK.25 However, the use of BCLs in pain relief post–pterygium surgery had mixed results. One randomized clinical trial found that the group with BCLs had faster corneal epithelial healing (measured with ultrahigh-resolution optical coherence tomography) and lower pain levels (according to visual analog scale scores) as compared with the control group.26 Another randomized clinical trial showed that BCLs resulted in more discomfort and pain and decreased quality of sleep as compared with tight bandage patching post–pterygium surgery.27

The actual mechanism responsible for the symptomatic pain relief after applying BCLs is not clearly established. However, a possible theory is that BCLs provide a mechanical shield to the eye resulting in less mechanical abrasion/contact from external eye structures such as eyelids.

Enhance Corneal Healing

In patients with corneal and OSDs, either bandage soft contact lenses or scleral lenses can be used to enhance corneal healing.

BCLs promote epithelialization by forming a scaffold and improving the spread of tear fluid over the ocular surface. In a comparative study, patients wearing BCLs for the treatment of neurotrophic keratitis had shorter corneal ulcer healing times compared with patients treated solely with eyedrops alone.28 BCLs, in particular SiHy lenses, are also effective in promoting healing in ocular chemical injuries.29 Bandage soft contact lenses were also investigated in the treatment of moderate to severe ocular graft-versus-host disease and found to be a safe, tolerable, and effective treatment option for patients who remained symptomatic despite conventional treatments.30

In severe OSDs, gas-permeable scleral contact lenses are often used (Table 2).31–43 In this article, we classify scleral lenses according to the resting zone area of the lens on the ocular surface (the current recommendation by the Scleral Lens Education Society)44 and move away from using diameter classification, which was the previous recommendation, since it would not be accurate for extremely large or small eyes.45 As such, corneal lenses are lenses which rest entirely on the cornea, corneo-scleral lenses are lenses which rest partly on the cornea and partly on the sclera, and scleral lenses are lenses which rest entirely on the sclera. Scleral lenses work by providing a tear-filled precorneal chamber and providing increased protection to the cornea from desiccation and friction.46 There have also been studies on the use of Prosthetic Replacement of Ocular Surface Ecosystem [PROSE; also known as Boston Scleral Lens, Boston Scleral Lens Prosthetic Device (BSLPD), or Boston Ocular Surface Prosthesis (BOSP)] in OSDs. In a retrospective review of all available records of patients fitted with Boston Scleral Lens in a center in the United States, it was found that this scleral lens is an important front line tool for the management of many severe corneal disorders refractory to other treatment measures or otherwise requiring keratoplasty.31 The most common indication was Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), followed by severe dry eye and neurotrophic disease.31 Other retrospective studies also concurred that scleral lenses improve symptoms, visual outcomes, and corneal healing in severe OSDs,32–34 and SJS/TEN.35,36 Esclera and BSLPD lenses have also been shown in prospective case series to improve visual acuity, dry eye symptoms, and quality of life in dry eye patients.37,38 In retrospective case series, PROSE lenses had also been shown to be successful in improving visual acuity and Ocular Surface Disease Index scores in patients with exposure keratopathy39,40 and SJS.41,42 Additionally, there are case reports which show that scleral lenses have been successfully used in specific conditions such as exposure and neurotrophic keratopathy,47 mucous membrane pemphigoid,48 and Graves ophthalmopathy.49

TABLE 2 - Therapeutic Use of Scleral Lenses in the Treatment of Corneal and Ocular Surface Diseases
Author Type of Study Indication of Scleral Lens No. Eyes Scleral Lens Type Outcome
Rosenthal and Croteau, 200531 Retrospective Severe OSD 875 Boston Scleral Lens Improved vision, reduced ocular pain and photophobia, healing of corneal defects
Scanzera et al, 201932 Retrospective OSD and CI 133 Patients Jupiter, BostonSight PROSE Visual outcomes improved with scleral CL for both indications —CI and OSD
Schornack et al, 201433 Retrospective OSD 188 Jupiter Improved comfort, ocular surface protection, or resolution of keratopathy achieved in all but 2 subjects
Jacobs and Rosenthal, 200737 Noncomparative interventional case series Dry eye from chronic GVHD 33 Patients BSLPD Improvement in pain, photophobia, and general QoL
Lee et al, 201834 Retrospective Severe refractory OSD 13 SoClear lens (corneo-scleral) Improvement in BCVA, CFS score, and PED
Tougeron-Brousseau et al, 200935 Retrospective SJS/TEN 67 SPOT Significant improvement in VA, OSDI, and NEI VFQ-25 scores
La Porta Weber et al, 201638 Prospective interventional case series Moderate to severe dry eye disease 41 Esclera Significantly improved BCVA, decreased tear osmolarity and van Bijsterveld scores, improved DES and QoL scores
Rathi et al, 201136 Retrospective CI and SJS 23 (CI); 20 (SJS) BOSP Improved VA and symptoms in both CI and SJS
Suarez et al, 201843 Prospective case series Keratoconus, post-PK, irregular astigmatism, severe OSD 39 ICD 16.5 mini–scleral lens Effective and safe option
Chahal et al, 201739 Retrospective interventional case series Exposure keratopathy 18 Patients PROSE Improvement in VA, OSDI, and corneal staining values
Wang et al, 201941 Retrospective interventional case series SJS in pediatric patients 49 Patients PROSE Significantly improved BCVA. 15 patients failed treatment
Heur et al, 201442 Retrospective interventional case series SJS 27 PROSE Significantly improved VA and OSDI scores
Kalwerisky et al, 201240 Retrospective interventional case series Exposure keratitis from severe periorbital thermal injuries 16 BOSP Successful rehabilitation of ocular surface with BOSP
BCVA indicates best-corrected visual acuity; BOSP, Boston Ocular Surface Prosthesis; BSLPD, Boston Scleral Lens Prosthetic Device; CFS, corneal fluorescein staining; CI, corneal irregularity; CL, contact lens; DES, dry eye symptoms; GVHD, graft-versus-host disease; NEI VFQ-25, National Eye Institute Visual Function Questionnaire-25; OSD, ocular surface disease; OSDI, Ocular Surface Disease Index; PED, persistent epithelial defect; PK, penetrating keratoplasty; PROSE, Prosthetic Replacement of the Ocular Surface Ecosystem; QoL, quality of life; SJS, Stevens-Johnson syndrome; TEN, toxic epidermal necrolysis; VA, visual acuity.
Art Optical Contact Lens, Inc., Grand Rapids, MI, USA, Clean & Bright Cooperation.
LAO, Thonon-les-Bains, France.

BCLs are widely used to enhance corneal healing post–ocular surgery, for example, after keratoplasty procedures such as penetrating keratoplasty.50 More recently, BCLs have been used after anterior lamellar keratoplasty and endothelial keratoplasty procedures (Fig. 1C). However, a recent randomized clinical trial has shown that there are no significant benefits of BCL application at the time of corneal transplantation.51 There was no difference in the speed of epithelialization between the BCL group and the control group. Certain limitations of this clinical trial include the relatively small sample size of 26 eyes and the use of hydrogel BCL instead of the newer, more effective SiHy lenses.51 Further studies on this subject are required to elucidate this matter. Other procedures requiring BCL include amniotic membrane transplantation (Fig. 1D).

A prospective randomized controlled study looked into the prophylactic use of BCL in the reduction of dry eye symptoms post-phacoemulsification and found that patients who wore BCLs for 1 week had statistically significant improvements in Ocular Surface Disease Index scores, subjective evaluation scores, tear break-up time, and fluorescein staining.52 Another randomized clinical trial which evaluated the use of therapeutic BCL in post-cataract patients concluded with similar findings of improved tear break-up time, tear meniscus height, subjective feeling, and corneal fluorescein staining in the BCL group compared with the control group.53

Some specialty soft therapeutic lenses (eg, Kontur, Richmond, Calif) have much larger diameters to facilitate coverage of the paralimbal region and the adjacent conjunctiva and have been used successfully in post-trabeculectomy cases to manage bleb-related complications such as bleb leaks, bleb enlargement in cases of hypotony and to prevent pain from conjunctival suture abrasive trauma to the eyelids. A prospective, randomized clinical trial has shown that post-trabeculectomy patients who wear soft BCLs (PureVision, 14 mm) had significantly higher mean intraocular pressure values, increased life table rates of surgical success, lower use of antiglaucoma medications, a more diffused bleb area, and lower incidence of encrusted blebs.54 In other studies, although the diameter of contact lens used is not standardized, large diameter contact lenses (14–20.5 mm) have been used in post-trabeculectomy patients and are effective in treating bleb leaks55–57 and early hypotony.58,59 The contact lens works by forming a barrier which reduces leak flow and by preventing transconjunctival filtration, promoting the restoration of the anterior chamber.

Corneal Protection

In patients with lid conditions such as trichiasis, post–ptosis surgery, recurrent corneal erosions, and tarsal scarring, the contact lens serves as a shield and protects the corneal surface from the eyelids and eyelashes.5 Together with eye lubrication and mechanical epilation, contact lenses are an established form of nonsurgical treatment for trichiasis.60 Although soft BCLs are usually used, a case series reports the use of PROSE in complex oculoplastic diseases and severe corneal surface diseases.61 Patients with ptosis showed improvement in marginal reflex distance after PROSE and many were spared further surgical intervention. Other patients with ectropion, entropion, or trichiasis also experienced improvement.61 In severe cicatricial entropion where surgical repair is difficult, a prospective cohort study showed that an acellular dermis allograft (ReDerm, Jieya company, Beijing, PR China) coupled with the use of TCLs is effective in treatment.62

Corneal Sealing

The contact lens acts as a splint for corneal perforations and lacerations and may be effective in sealing small perforations and lacerations with and without adhesives63 (Fig. 2). A study conducted at the Singapore National Eye Center by Lim et al64 reported effective use of silicone-hydrogel lenses (Bausch and Lomb PureVision Lenses, Rochester, NY) for corneal wound sealing purposes in corneal perforations <2 mm in diameter. Even in larger corneal perforations, fibrin glue and therapeutic BCLs are often used as a temporizing measure before penetrating keratoplasty, since outcomes for penetrating keratoplasty are often poor in the presence of active inflammation.65,66

Management of corneal perforation with cyanoacrylate glue and bandage lens. (A, B) 2 mm corneal perforation following herpetic stromal keratitis showing the iris plugging the perforation. (C) Cyanoacrylate corneal gluing for corneal sealing with bandage lens application. (D, E) 6 months later, the cornea healed with fibrosis and vascularization under the cyanoacrylate glue with spontaneous dislodgement of the glue.

Drug Delivery

Ocular drug delivery involves achieving therapeutic concentrations of medication at the ocular surface. This is traditionally achieved through eye drops, sometimes frequent dosing is necessary to achieve therapeutic concentrations. Unfortunately, frequent dosing is inconvenient, not cost-effective, and often leads to patient noncompliance. To overcome these limitations found in conventional eye drop treatment, novel delivery systems and devices have been explored. It is suggested that therapeutic lenses may be suitable for controlled and sustained drug delivery due to their extended-wear function and higher bioavailability than eye drop formulations.67 The drug delivery techniques include soaking method, molecular imprinting, entrapment of drug-laden colloidal nanoparticles, drug plate, ion ligand polymeric systems, and superficial fluid technology.68–70

Contact lenses can be either presoaked or postsoaked in a drug solution. Presoaked means that contact lenses are soaked in the drug solution before application on the ocular surface, whereas postsoaked refers to applying the contact lens first on the ocular surface before placing eye drops on the lens. Contact lenses, being hydrophilic, can be used for prolonged release of medication onto the ocular surface.71,72 Simulation and in vitro experiments have shown promising results—drug delivery from a contact lens is more efficient than drug delivery by eye drops, with larger fractional uptake and higher bioavailability.73–75 Particle-laden contact lenses have also been investigated in drug delivery. These lenses have colloidal particles (commonly liposomes) embedded in them for sustained delivery. Both in vitro and ex vivo studies have shown liposomal contact lenses to be biocompatible.76 The liposomes embedded in the contact lenses also do not affect transmittance within the visible light range.76 Drug delivery modalities such as molecular imprinting and ion ligands bind specific molecules and are promising in providing targeted drug delivery.

Although research on TCLs in drug delivery appears promising, there are currently limited clinical and commercial applications. Possible areas of application include the use of contact lenses in prophylactic antibiotic delivery, especially for extended contact lens wear, and in the delivery of glaucoma therapy. Basic lens properties such as transparency, water content, drug stability, drug release, swelling, and storage modulus and other properties affecting comfort such as ion and oxygen permeability need to be addressed before commercialization.


Therapeutic lenses frequently need to be worn on an extended-wear basis and hence need to have a high oxygen transmissibility (Dk/L) to be suitable. The critical lens oxygen transmissibility needed to limit overnight corneal edema to 4% (the level experienced without a contact lens in place) was found to be 87 × 10–9 (cm × mLO2)/(s × mL × mm Hg).77 Currently, most silicone-hydrogel lenses, but not hydrogel lenses, are able to fulfill this criteria (Table 3).

TABLE 3 - FDA-Approved Therapeutic Soft Contact Lenses
Trade Name Lens Material Dk/H2O Base Curve, mm Powers (D)
Acuvue Oasys (Vistakon) Senofilcon A 103/38 8.4, 8.8 +8.00 to −12.00
PureVision (Bausch + Lomb) Balafilcon A 99/36 8.3, 8.6 +6.00 to −12.00
Air Optix Night & Day Aqua (Alcon) Lotrafilcon A 140/24 8.4, 8.6 +6.00 to −10.00
D inicates diopter; Dk, oxygen permeability; FDA, US Food and Drug Administration; H2O, water content.

In the fitting of bandage soft contact lenses, the diameter of the soft lenses should be ≥13.5 mm for full corneal coverage and larger lenses (eg, Kontur lenses) may be required in certain conditions such as post–glaucoma filtration surgery cases. Commercially available therapeutic SiHy lenses frequently have limited base curvature options (usually 2, eg, 8.4 and 8.8 mm in Johnson and Johnson Acuvue Oasys lenses, Jacksonville, FL) and hence these lenses may not fit the whole range of corneal and OSDs, especially in post-keratoplasty eyes. The standard principles of contact lens fitting should be adhered and steep or flat fitting lenses avoided.

Prophylactic topical antibiotics are recommended in therapeutic lens wear as the risk of infective keratitis is higher in extended lens wear than daily lens wear. The use of single-use, preservative-free eyedrops is preferred where possible. In long-term bandage lens wear, periodic replacement, for example, monthly, to avoid protein and microbial buildup is important. The patient should be informed about the potential risks of TCL wear and followed up at regular intervals to check for complications.


Although TCLs have many uses, there are certain contraindications that must be considered. These include infective keratitis, corneal anesthesia, and significant exposure keratopathy with inadequate eyelid position or movement. Therapeutic lens wear in infective keratitis may lead to worsening of the infective process and should be avoided.

A relative contraindication of therapeutic lens wear is corneal anesthesia. These patients have reduced pain sensation, lacrimal and blink reflex, and may be unable to detect symptoms of complications. In these patients, it is permissible to use contact lenses with close follow-up to detect intolerance or early complications. For patients with significant lagophthalmos and exposure keratopathy, localized drying of the contact lens surface would cause discomfort and mechanical abrasions to the ocular surface limiting its use.


Infective keratitis is one of the most devastating complications of contact lens wear. In a landmark Australian surveillance study by Stapleton et al,78 the annualized incidence of microbial keratitis in contact lens wearers (per 10,000 wearers) was described. Overnight contact lens wearers had a much higher incidence of microbial keratitis than daily-wear contact lens wearers, with the highest incidence of microbial keratitis seen in overnight SiHy wearers [25.4 (21.2–31.5)], even compared with overnight conventional soft lens wearers [19.5 (14.6–29.5)] despite higher oxygen transmissibility in SiHy lenses. Pure daily-wear soft lens wearers had a much lower incidence of microbial keratitis [1.9 (1.8–2.0)] and the lowest incidence was seen in daily-wear rigid gas-permeable lens wearers [1.2 (1.1–1.5)].78 For this reason, prophylactic antibiotics are used for extended contact lens wear. Poor hygiene, extended wear, and low oxygen permeability are contributing factors associated with a higher incidence of infections.79–81 The most common organism in infective keratitis is Pseudomonas aeruginosa. Other organisms included Staphylococcus, Streptococcus, Serratia, and Acanthamoeba. Bacterial corneal ulcers can potentially be sight-threatening and require prompt broad-spectrum empiric antibiotics whereas the treatment of Acanthamoeba keratitis involves a cocktail of antiamoebic drugs.82

Hydrogel lenses with low oxygen transmissibility can cause significant corneal hypoxia if worn on an extended-wear basis. Signs of corneal hypoxia include corneal stromal and epithelial edema with microcyst formation, corneal neovascularization, and endothelial complications.83 SiHy lenses with higher oxygen transmissibility are therefore preferred.

Contact lens wear can also result in allergies and inflammation. Papillary conjunctivitis, sterile inflammatory reactions, and in severe cases, anterior chamber flare and cellular reactions can develop.84–86

Poor fit of the contact lens can also result in certain complications. For lenses that are too steeply fit, a sucked-on-lens syndrome or anterior segment ischemia can develop. In patients with severe dry eye, lens loss can also occur due to the lack of surface tension.


An algorithm shown in Figure 3 illustrates certain factors that should be considered before deciding on the use of TCLs. There are many indications and uses of TCLs in alleviating ocular pain, enhancing corneal healing, corneal protection, and corneal sealing. Recent advances in technology and research have also shown contact lenses to be promising in the use for drug delivery. However, there are certain contraindications of the use of TCLs that must be considered. These include infective keratitis, corneal anesthesia, and significant exposure keratopathy with inadequate eyelid position or movement. Complications of extended contact lens wear can also occur. There is a higher incidence of infective keratitis, the most devastating complication, in extended contact lens wear. Therefore, prophylactic antibiotics should be used. Patients should also be monitored for other complications such as corneal hypoxia leading to corneal edema and neovascularization, corneal inflammation, and allergic conjunctivitis.

Algorithm for therapeutic contact lens wear.


1. Bielory BP, Shah SP, O’Brien TP, et al. Emerging therapeutics for ocular surface disease. Curr Opin Allergy Clin Immunol 2016; 16:477–486.
2. Andrew NC, Woodward EG. The bandage lens in bullous keratopathy. Ophthalmic Physiol Opt 1989; 9:66–68.
3. Montero J, Sparholt J, Mely R. Retrospective case series of therapeutic applications of a Lotrafilcon A silicone-hydrogel soft contact lens. Eye Contact Lens 2003; 29: (1 suppl): S54–S56. discussion S57–S59, S192–S194.
4. Rashad R, Weed MC, Quinn N, et al. Extended-wear bandage contact lenses decrease pain and preserve vision in patients with epidermolysis bullosa: case series and review of literature. Ocul Immunol Inflamm 2020; 28:379–383.
5. Miller DD, Hasan SA, Simmons NL, et al. Recurrent corneal erosion: a comprehensive review. Clin Ophthalmol 2019; 13:325–335.
6. Ahad MA, Anandan M, Tah V, et al. Randomized controlled study of ocular lubrication versus bandage contact lens in the primary treatment of recurrent corneal erosion syndrome. Cornea 2013; 32:1311–1314.
7. Cherry PM. The treatment of pain following excimer laser photorefractive keratectomy: additive effect of local anesthetic drops, topical diclofenac, and bandage soft contact. Ophthalmic Surg Lasers 1996; 27: (5 suppl): S477–S480.
8. Taneri S, Oehler S, MacRae S, et al. Influence of a therapeutic soft contact lens on epithelial healing, visual recovery, haze, and pain after photorefractive keratectomy. Eye Contact Lens 2018; 44: (suppl 1): S38–S43.
9. Xie WJ, Zeng J, Cui Y, et al. Comparation of effectiveness of silicone-hydrogel contact lens and hydrogel contact lens in patients after LASEK. Int J Ophthalmol 2015; 8:1131–1135.
10. Sanchez-Gonzalez JM, Lopez-Izquierdo I, Gargallo-Martinez B, et al. Bandage contact lens use after photorefractive keratectomy. J Cataract Refract Surg 2019; 45:1183–1190.
11. Grentzelos MA, Plainis S, Astyrakakis NI, et al. Efficacy of 2 types of silicone-hydrogel bandage contact lenses after photorefractive keratectomy. J Cataract Refract Surg 2009; 35:2103–2108.
12. Taylor KR, Caldwell MC, Payne AM, et al. Comparison of 3 silicone-hydrogel bandage soft contact lenses for pain control after photorefractive keratectomy. J Cataract Refract Surg 2014; 40:1798–1804.
13. Taylor KR, Molchan RP, Townley JR, et al. The effect of silicone-hydrogel bandage soft contact lens base curvature on comfort and outcomes after photorefractive keratectomy. Eye Contact Lens 2015; 41:77–83.
14. Mohammadpour M, Amouzegar A, Hashemi H, et al. Comparison of Lotrafilcon B and Balafilcon A silicone-hydrogel bandage contact lenses in reducing pain and discomfort after photorefractive keratectomy: a contralateral eye study. Cont Lens Anterior Eye 2015; 38:211–214.
15. Mohammadpour M, Heidari Z, Hashemi H, et al. Comparison of the Lotrafilcon B and Comfilcon A silicone-hydrogel bandage contact lens on postoperative ocular discomfort after photorefractive keratectomy. Eye Contact Lens 2018; 44: (suppl 2): S273–S276.
16. Mohammadpour M, Shakoor D, Hashemi H, et al. Comparison of bandage contact lens removal on the fourth versus seventh postoperative day after photorefractive keratectomy: a randomized clinical trial. J Curr Ophthalmol 2017; 29:103–107.
17. Engle AT, Laurent JM, Schallhorn SC, et al. Masked comparison of silicone-hydrogel Lotrafilcon A and Etafilcon A extended-wear bandage contact lenses after photorefractive keratectomy. J Cataract Refract Surg 2005; 31:681–686.
18. Plaka A, Grentzelos MA, Astyrakakis NI, et al. Efficacy of two silicone-hydrogel contact lenses for bandage use after photorefractive keratectomy. Cont Lens Anterior Eye 2013; 36:243–246.
19. Edwards JD, Bower KS, Sediq DA, et al. Effects of Lotrafilcon A and Omafilcon A bandage contact lenses on visual outcomes after photorefractive keratectomy. J Cataract Refract Surg 2008; 34:1288–1294.
20. Eliacik M, Erdur SK, Gulkilik G, et al. Compare the effects of two silicone-hydrogel bandage contact lenses on epithelial healing after photorefractive keratectomy with anterior segment optical coherence tomography. Cont Lens Anterior Eye 2015; 38:215–219.
21. Mukherjee A, Ioannides A, Aslanides I. Comparative evaluation of Comfilcon A and Senofilcon A bandage contact lenses after transepithelial photorefractive keratectomy. J Optom 2015; 8:27–32.
22. Razmjoo H, Abdi E, Atashkadi S, et al. Comparative study of two silicone-hydrogel contact lenses used as bandage contact lenses after photorefractive keratectomy. Int J Prev Med 2012; 3:718–722.
23. Yuksel E, Ozulken K, Uzel MM, et al. Comparison of Samfilcon A and Lotrafilcon B silicone-hydrogel bandage contact lenses in reducing postoperative pain and accelerating re-epithelialization after photorefractive keratectomy. Int Ophthalmol 2019; 39:2569–2574.
24. Daglioglu MC, Coskun M, Ilhan N, et al. The effects of soft contact lens use on cornea and patient's recovery after autograft pterygium surgery. Cont Lens Anterior Eye 2014; 37:175–177.
25. Zhao LQ, Li LM, Liu J, et al. Bandage contact lens application reduces fibrotic wound healing of flap margins after FS-LASIK: a prospective randomized clinical trial. J Ophthalmol 2019; 3074659.
26. Chen D, Lian Y, Li J, et al. Monitor corneal epithelial healing under bandage contact lens using ultrahigh-resolution optical coherence tomography after pterygium surgery. Eye Contact Lens 2014; 40:175–180.
27. Prat D, Zloto O, Ben Artsi E, et al. Therapeutic contact lenses vs tight bandage patching and pain following pterygium excision: a prospective randomized controlled study. Graefes Arch Clin Exp Ophthalmol 2018; 256:2143–2148.
28. Sun YZ, Guo L, Zhang FS. Curative effect assessment of bandage contact lens in neurogenic keratitis. Int J Ophthalmol 2014; 7:980–983.
29. Baradaran-Rafii A, Eslani M, Haq Z, et al. Current and upcoming therapies for ocular surface chemical injuries. Ocul Surf 2017; 15:48–64.
30. Inamoto Y, Sun YC, Flowers ME, et al. Bandage soft contact lenses for ocular graft-versus-host disease. Biol Blood Marrow Transplant 2015; 21:2002–2007.
31. Rosenthal P, Croteau A. Fluid-ventilated, gas-permeable scleral contact lens is an effective option for managing severe ocular surface disease and many corneal disorders that would otherwise require penetrating keratoplasty. Eye Contact Lens 2005; 31:130–134.
32. Scanzera AC, Bontu S, Joslin CE, et al. Prevalence of ocular surface disease and corneal irregularity and outcomes in patients using therapeutic scleral lenses at a tertiary care center [published online ahead of print November 29, 2019]. Eye Contact Lens doi:10.1097/ICL.0000000000000679.
33. Schornack MM, Pyle J, Patel SV. Scleral lenses in the management of ocular surface disease. Ophthalmology 2014; 121:1398–1405.
34. Lee SM, Kim YJ, Choi SH, et al. Long-term effect of corneo-scleral contact lenses on refractory ocular surface diseases. Cont Lens Anterior Eye 2019; 42:399–405.
35. Tougeron-Brousseau B, Delcampe A, Gueudry J, et al. Vision-related function after scleral lens fitting in ocular complications of Stevens-Johnson syndrome and toxic epidermal necrolysis. Am J Ophthalmol 2009; 148:852–859.
36. Rathi VM, Mandathara PS, Dumpati S, et al. Boston Ocular Surface Prosthesis: an Indian experience. Indian J Ophthalmol 2011; 59:279–281.
37. Jacobs DS, Rosenthal P. Boston Scleral Lens Prosthetic Device for treatment of severe dry eye in chronic graft-versus-host disease. Cornea 2007; 26:1195–1199.
38. La Porta Weber S, Becco de Souza R, Gomes JAP, et al. The use of the Esclera Scleral Contact Lens in the treatment of moderate to severe dry eye disease. Am J Ophthalmol 2016; 163:167–173.
39. Chahal JS, Heur M, Chiu GB. Prosthetic Replacement of the Ocular Surface Ecosystem scleral lens therapy for exposure keratopathy. Eye Contact Lens 2017; 43:240–244.
40. Kalwerisky K, Davies B, Mihora L, et al. Use of the Boston Ocular Surface Prosthesis in the management of severe periorbital thermal injuries: a case series of 10 patients. Ophthalmology 2012; 119:516–521.
41. Wang Y, Rao R, Jacobs DS, et al. Prosthetic Replacement of the Ocular Surface Ecosystem Treatment for ocular surface disease in pediatric patients with Stevens-Johnson syndrome. Am J Ophthalmol 2019; 201:1–8.
42. Heur M, Bach D, Theophanous C, et al. Prosthetic Replacement of the Ocular Surface Ecosystem scleral lens therapy for patients with ocular symptoms of chronic Stevens-Johnson syndrome. Am J Ophthalmol 2014; 158:49–54.
43. Suarez C, Madariaga V, Lepage B, et al. First experience with the ICD 16.5 mini–scleral lens for optic and therapeutic purposes. Eye Contact Lens 2018; 44:44–49.
44. van der Worp E. A Guide to Scleral Lens Fitting. 2nd ed. United States: Pacific University; 2015.
45. van der Worp E. A Guide to Scleral Lens Fitting. United States: Pacific University; 2010.
46. Rosenthal P, Cotter J. The Boston Scleral Lens in the management of severe ocular surface disease. Ophthalmol Clin North Am 2003; 16:89–93.
47. Grey F, Carley F, Biswas S, et al. Scleral contact lens management of bilateral exposure and neurotrophic keratopathy. Cont Lens Anterior Eye 2012; 35:288–291.
48. Kumar M, Shetty R, Jayadev C. Role of mini–scleral lens in mucous membrane pemphigoid. Indian J Ophthalmol 2017; 65:320–322.
49. Harthan JS. Therapeutic use of mini–scleral lenses in a patient with Graves ophthalmopathy. J Optom 2014; 7:62–66.
50. Aquavella JV, Shaw EL. Hydrophilic bandages in penetrating keratoplasty. Ann Ophthalmol 1976; 8:1207–1219.
51. Shimazaki J, Shigeyasu C, Saijo-Ban Y, et al. Effectiveness of bandage contact lens application in corneal epithelialization and pain alleviation following corneal transplantation; prospective, randomized clinical trial. BMC Ophthalmol 2016; 16:174.
52. Chen X, Yuan R, Sun M, et al. Efficacy of an ocular bandage contact lens for the treatment of dry eye after phacoemulsification. BMC Ophthalmol 2019; 19:13.
53. Shi DN, Song H, Ding T, et al. Evaluation of the safety and efficacy of therapeutic bandage contact lenses on post–cataract surgery patients. Int J Ophthalmol 2018; 11:230–234.
54. Li B, Zhang M, Yang Z. Study of the efficacy and safety of contact lens used in trabeculectomy. J Ophthalmol 2019; 1839712.
55. Blok MD, Kok JH, van Mil C, et al. Use of the Megasoft bandage lens for treatment of complications after trabeculectomy. Am J Ophthalmol 1990; 110:264–268.
56. Fourman S, Wiley L. Use of a collagen shield to treat a glaucoma filter bleb leak. Am J Ophthalmol 1989; 107:673–674.
57. Wu Z, Huang C, Huang Y, et al. Soft bandage contact lenses in management of early bleb leak following trabeculectomy. Eye Sci 2015; 30:13–17.
58. Smith MF, Doyle JW. Use of oversized bandage soft contact lenses in the management of early hypotony following filtration surgery. Ophthalmic Surg Lasers 1996; 27:417–421.
59. Shoham A, Tessler Z, Finkelman Y, et al. Large soft contact lenses in the management of leaking blebs. CLAO J 2000; 26:37–39.
60. Ferreira IS, Bernardes TF, Bonfioli AA, et al. Semin Ophthalmol 2010; 25:66–71.
61. Scofield-Kaplan SM, Dunbar KE, Campbell AA, et al. Utility of PROSE device in the management of complex oculoplastic pathology. Ophthalmic Plast Reconstr Surg 2018; 34:242–245.
62. Gu J, Wang Z, Sun M, et al. Posterior lamellar eyelid reconstruction with acellular dermis allograft in severe cicatricial entropion. Ann Plast Surg 2009; 62:268–274.
63. Jhanji V, Young AL, Mehta JS, et al. Management of corneal perforation. Surv Ophthalmol 2011; 56:522–538.
64. Lim L, Tan DT, Chan WK. Therapeutic use of Bausch & Lomb PureVision contact lenses. CLAO J 2001; 27:179–185.
65. Sharma A, Kaur R, Kumar S, et al. Fibrin glue versus N-butyl-2-cyanoacrylate in corneal perforations. Ophthalmology 2003; 110:291–298.
66. Rana M, Savant V. A brief review of techniques used to seal corneal perforation using cyanoacrylate tissue adhesive. Cont Lens Anterior Eye 2013; 36:156–158.
67. Peng CC, Burke MT, Carbia BE, et al. Extended drug delivery by contact lenses for glaucoma therapy. J Control Release 2012; 162:152–158.
68. Xinming L, Yingde C, Lloyd AW, et al. Polymeric hydrogels for novel contact lens–based ophthalmic drug delivery systems: a review. Cont Lens Anterior Eye 2008; 31:57–64.
69. Guzman-Aranguez A, Colligris B, Pintor J. Contact lenses: promising devices for ocular drug delivery. J Ocul Pharmacol Ther 2013; 29:189–199.
70. Carvalho IM, Marques CS, Oliveira RS, et al. Sustained drug release by contact lenses for glaucoma treatment—a review. J Control Release 2015; 202:76–82.
71. Peterson RC, Wolffsohn JS, Nick J, et al. Clinical performance of daily disposable soft contact lenses using sustained release technology. Cont Lens Anterior Eye 2006; 29:127–134.
72. Schrader S, Wedel T, Moll R, et al. Combination of serum eye drops with hydrogel bandage contact lenses in the treatment of persistent epithelial defects. Graefes Arch Clin Exp Ophthalmol 2006; 244:1345–1349.
73. Li CC, Chauhan A. Modeling ophthalmic drug delivery by soaked contact lenses. Ind Eng Chem Res 2006; 45:3718–3734.
74. Li CC, Chauhan A. Ocular transport model for ophthalmic delivery of timolol through p-HEMA contact lenses. J Drug Deliv Sci Technol 2007; 17:69–79.
75. Kim J, Chauhan A. Dexamethasone transport and ocular delivery from poly (hydroxyethyl methacrylate) gels. Int J Pharm 2008; 353:205–222.
76. Danion A, Doillon CJ, Giasson CJ, et al. Biocompatibility and light transmission of liposomal lenses. Optom Vis Sci 2007; 84:954–961.
77. Holden BA, Mertz GW. Critical oxygen levels to avoid corneal edema for daily- and extended-wear contact lenses. Invest Ophthalmol Vis Sci 1984; 25:1161–1167.
78. Stapleton F, Keay L, Edwards K, et al. The incidence of contact lens–related microbial keratitis in Australia. Ophthalmology 2008; 115:1655–1662.
79. Liesegang TJ. Contact lens–related microbial keratitis: part I: epidemiology. Cornea 1997; 16:125–131.
80. Schein OD, Buehler PO, Stamler JF, et al. The impact of overnight wear on the risk of contact lens–associated ulcerative keratitis. Arch Ophthalmol 1994; 112:186–190.
81. Schein OD, Glynn RJ, Poggio EC, et al. The relative risk of ulcerative keratitis among users of daily-wear and extended-wear soft contact lenses. A case-control study. Microbial Keratitis Study Group. N Engl J Med 1989; 321:773–778.
82. Lorenzo-Morales J, Khan NA, Walochnik J. An update on Acanthamoeba keratitis: diagnosis, pathogenesis, and treatment. Parasite 2015; 22:10.
83. White PF, Miller D. Complications of contact lenses: physiological complications—corneal edema. Int Ophthalmol Clin 1981; 21:3–12.
84. Donshik PC. Giant papillary conjunctivitis. Trans Am Ophthalmol Soc 1994; 92:687–744.
85. Donshik PC, Suchecki JK, Ehlers WH. Peripheral corneal infiltrates associated with contact lens wear. Trans Am Ophthalmol Soc 1995; 93:49–60. discussion 60–44.
86. Baum J, Dabezies OH Jr. Pathogenesis and treatment of “sterile” midperipheral corneal infiltrates associated with soft contact lens use. Cornea 2000; 19:777–781.

bandage lens; corneal disease; ocular surface disease; scleral lens; therapeutic contact lens

Copyright © 2020 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.