Lasik followed by Retinal Detachment, then Pain

Over the years I have been asked about scleral lenses and eye pain many times. The 2 images below are of the same eye. This patient underwent LASIK surgery about 15 years ago. 3 years later this eye suffered a 360 degree retinal detachment which created a completely blind eye (no light perception). About 3 years ago this eye became so painful that this patient was contemplating having the eye removed. After visiting a number of eye care providers seeking relief from this pain without success this patient was referred to my office for help. In all my years of practice this was the most debilitated painful eye that I had ever seen. I fit this eye was a specially designed scleral lens with the intention of protecting the compromised cornea from the environment and the blinking action of the eyelids. Look carefully at the first photo and you can see the cloudy, scarred, blood vessel filled cornea with a scleral lens over it. The 2nd image is a cross section of the same cornea with the scleral lens over it. In this image, the top 2 curved lines are the front and back surfaces of the scleral lens. The thick curved grey structure is the compromised cornea. Again, look carefully and notice the split in the center of the cornea. This is the LASIK flap separating the anterior cornea from the underlying cornea. Also note that the outer layer of the cornea (the corneal epithelium) is coming “unglued” a condition known as “bullous keratopathy”. This patient has been able to function pain free for the past 2 years with the scleral lens even though this is a blind eye. It is amazing that this patient was very happy with his vision for the 3 years following his LASIK procedure.

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