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Q. My husband wears contact lens for aphakic bullous keratopathy and is getting pain now. Why?

Answered by
Dr. Dada Peer K
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 06, 2019

Hello doctor,

For ten years, my husband has been successfully using an extended wear bandage contact lens (monthly wear) to control the pain of aphakic bullous keratopathy in one eye. About seven months ago, he had an episode of foreign body pain in the eye which the contact lens could not control. His optometrist changed the type of lens after remarking that the lens appeared tight. Although the painful sensations have decreased, they are still present with more of a sore feeling now. His ophthalmologist suggested that he discontinue the Azopt drops he had been using in case the preservative was causing some corneal toxicity.

His eye pressure without the drops has read at 18 and 20 on separate occasions, but he does have corneal edema which may affect the measurement. He has had high pressure in that eye previously, but it was mostly lowered by Cyclodiode treatment some eight years ago. The consultant said he had left him on the Azopt drops just as a precaution. My query is that if the bandage lens has worked so well for pain management for 10 years is it possible that it can continue to work? And if the Azopt drops and their preservative had caused some toxic reaction seven months ago, could that still be causing him to feel the discomfort? His consultant suggested out that he could have the eye removed to control the pain, but as he has what he feels is some slight, useful vision in that eye, he does not want to take such a drastic and life-changing step. In fact, he wants to pursue the least invasive course of action to relieve the pain he is getting. I would appreciate any advice you could give as he is in quite a bit of pain.

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Hello,

Welcome to icliniq.com.

I reviewed your history. Bandage contact lenses are a proven and effective treatment option for pain relief in case of aphakic bullous keratopathy. Hence he can continue the same and I do not think these are responsible for the sore feeling of the eyes. For symptomatic relief, he can use artificial tears eye drops like Refresh tears eye drops.

The removal of the eye ball called enucleation is the last step required in case of a painful eye and I do not think your husband needs this one at this moment. The other options that can be tried are laser phototherapeutic keratectomy. Hence I advise you to discuss with your doctor regarding all these aspects before planning further courses of treatment.

I hope this helps.


The Probable causes:

Damage to the corneal endothelium.

Investigations to be done:

Measurement of intraocular pressure.

Differential diagnosis:

Corneal edema.

Treatment plan:

Artificial tears eye drops like refresh tears, hypertonic saline eye drops, laser phototherapeutic keratectomy.

Regarding follow up:

Once in three months depending on the severity.


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