What would Picasso Do? The Role of Facial Structure in Scleral Lens Fitting
Christine Sindt OD FAAO FSLS Tom Arnold OD FSLS Professor, Clinical Memorial Eye Center Ophthalmology Sugar Land Texas Director, Contact Lens Service University of Iowa Disclosures
Christine Sindt OD FAAO FSLS Tom Arnold OD FSLS
❑ President: EyePrint Prosthetics ❑ EyePrint Prosthetics ❑ Grant Support: MDM Optical ❑ Blanchard Lab ❑ Bausch & Lomb SVP ❑ BostonSight ❑ Oculus USA ❑ signed releases for all images used in this lecture
FACIAL AGING
❑ THINNING OF THE DERMIS AND ATROPHY OF FAT PADS
❑ LOSS OF ELASTICITY ❑ GREATER VISIBILITY OF BONY LANDMARKS, BLOOD VESSELS, WRINKLES, AND FURROWS
❑ TRANSVERSE FOREHEAD LINES ❑ LOWERING OF THE EYEBROWS ❑ DESCENT OF CORNERS OF LIDS ❑ PTOSIS OF NASAL TIP PERIOCULAR FACIAL AGING THAT AFFECT SCLERAL LENS WEAR
❑ BROW PTOSIS – DROOPING POSITION OF BROW/FOREHEAD ❑ BROW OR FOREHEAD LIFT ❑ DERMATOCHALASIS – REDUNDANT EYELID SKIN ❑ BLEPHAROPLASTY ❑ BLEPHAROPTOSIS (PTOSIS) – DROOPING POSITION OF EYELID ❑ LEVATOR REPAIR OR MULLERECTOMY ❑ MIDFACE PTOSIS – DROOPING POSITION OF CHEEKS/MIDFACE ❑ MIDFACE OR SOOF (SUBORBICULARIS OCULI FAT) LIFT PRE-SCLERAL LENS FITTING EVALUATION
❑ DISCUSS PATIENT GOALS, EXPECTATIONS, AND SYMPTOMS ❑ ASSESS FACIAL ASYMMETRY ❑ LOOK FOR BROW / EYELID/ EYELASH PTOSIS ❑ EVALUATE MEIBOMIAN GLAND FUNCTION / LID WIPER/ GPC
❑ NOTE PRESENCE OF BELL’S PHENOMENON ❑ NOTE LID MARGIN POSITIONS ❑ ENTROPIAN/ EXTROPIAN ❑ SPRINGBACK TEST FOR LOWER LIDS ❑ EXPOSURE ❑ PRE-FITTING PHOTOS Bell’s Phenomenon HOW TO EXAMINE FOR BROW AFFECTING FIT LOOK FOR ASYMMETRIC FOREHEAD FURROWS
PATIENT UPON INITIAL ONCE PATIENT FULLY EVALUATION RELAXED BROW MUSCLES BROW/ PTOSIS
WEARING SCLERAL LENS WITHOUT SCLERAL LENSES OS BROW AND BLEPHAROPTOSIS
Brow Tension Blepharopstosis when brow Post-surgical released LASH PTOSIS AND LID WIPER Lash Ptosis
• Anatomical changes within the eyelid
❑ Orbicularis oculi ❑ Riolan muscle ❑ Loss of muscle elasticity = loss of follicle support
❑ Tarsal plate ❑ Deficiency of elastin • Surgical correction for blepharoptosis
Lash Ptosis in Congenital and Acquired Blepharoptosis Arch Ophthalmol. 2007;125(12):1613-1615 LASH PTOSIS CAUSING ANTERIOR DISPLACEMENT OF THE MUCOCUTANEOUS JUNCTION FLOPPY EYELIDS Floppy Eyelid – note the lash ptosis OS
• Note the lash ptosis OS GIANT PAPILLARY CONJUNCTIVITIS UNDERLYING FACIAL LIGAMENT AND BONE STRUCTURE
❑OSSEO-CUTANEOUS FACIAL LIGAMENTS COMPRISE THE PRIMARY STRUCTURAL DIVISIONS OF THE FACIAL FAT COMPARTMENTS
❑FACIAL FAT DESCENDS AND FAT VOLUME DECREASES
❑LOWER LID DROOP
J Cutan Aesthet Surg. 2016 Apr-Jun;9(2):65-72 SCLERAL LENS EQUIVALENT OF 3 – 9 STAINING Case Example –post LASIK ectasia Fit elsewhere The solution? EyePrint Pro
Perfect fit!
❑ So? What’s the problem? LOWER LID DROOP CAUSING EXPOSURE
DISCOMFORT BLAMED ON TEMP. THIGHTENING LOWER LID PINGUECULA EXPOSURE IMPROVED COMFORT After surgical correction – lateral tarsal strip Exposure from High Upper Lid Warning Sign
Ectropion
Educate patients about their lid condition and how it may affect their wearing success Severe entropion with trichiasis Treatment– scleral lens to protect cornea Diagnosis - ocular cicatricial pemphigoid Much improved! BROW PTOSIS Summary ❑
❑ DERMATOCHALASIS
❑ PTOSIS
❑ Pinching
❑ Irritation
❑ Headaches
❑ Feelings of dryness
❑ MIDFACE PTOSIS
❑ LATERAL LID DROOP ❑ Exposure ❑ Irritation ❑ Redness ❑ Limited wear Summary
• TELL THEM BEFORE YOU FIT THEM!