Placement and Removal of Bandage Contact Lens

Abstract

Contact lens insertion and removal proficiency is paramount to successful resolution in several sight-threatening ocular conditions. With contact lenses so often being the culprit for corneal ulcers, it may seem counterintuitive to use them as a Band-Aid. However, in many cases of ocular trauma such as corneal abrasion and foreign body removal, a bandage contact lens along with topical antibiotics is an advisable form of treatment. Bandage contact lenses are also heavily utilized in surgical refractive procedures such as photorefractive keratectomy (PRK) and epi-off corneal cross-linking. There are many new advances in bandage contact lens technology such as contact lenses eluted with antibiotics, steroids, and amniotic tissues for managing both chronic and acute ocular conditions.

Indications and Contraindications

Indications in trauma or chronic conditions:^1,2,3

• Recurrent corneal erosion
• Corneal abrasion
• Non-resolving or severe exposure keratitis
• Dry eye syndrome
• Temporary cases of corneal rupture
• Bullous keratopathy
• Stevens-Johnson Syndrome
• Small corneal perforations
• Trichiasis

Indications for post-surgical cornea whenever corneal epithelium is disrupted:^1,2,3

• Laser-assisted in situ keratomileusis (LASIK)
• Photorefractve keratectomy (PRK)
• Corneal cross-linking (epi-off)
• Superficial keratectomy
• Pterygium resection
• Cataract surgery

Contraindications:³

• Active infective keratitis (absolute)
• Corneal anesthesia (relative)

Equipment

• Slit lamp
• Fluorescein
• Silicone hydrogel contact lens

Exam and Potential complications

Exam flow:⁴

1. Examine cornea with and without fluorescein to determine the diagnosis and need for bandage contact lens.
2. Educate the patient about the need for contact lens and the likely relief it will bring as it acts like a Band-Aid.
3. Wash hands with soap and water. This is preferred over alcohol-based sanitizers in order to avoid alcohol in the eye. Assess contact lens orientation on the tip of your index finger on your dominant hand.
4. Brace the patient's eyelids by having them look opposite of the lid you are trying to hold. Apply pressure between the eyelid and bones of the orbit for maximum control.
5. Place the contact lens on the conjunctiva or cornea and have the patient close their eyelids slowly. After the contact lens is adhered, check to make sure the contact lens is on the eye over the cornea (with a slit lamp if you have access).
6. Explain that the patient will wear the contact lens 24 hours per day and they must use antibiotic drops concurrently. Depending on severity of ailment, frequent drop instillation and follow up will be required. Refer the patient to an eye doctor for prompt contact lens removal and disease monitoring.

Potential complications:^1,3

• Infection
• Limited resolution of condition for which bandage contact lens was applied
• Corneal edema due to hypoxia

Discussion

Bandage contact lenses used along with topical antibiotics and/or steroids can be a very effective treatment for corneal abrasions, recurrent corneal erosions, and postsurgical corneas such as the refractive procedure PRK.^1,2,3,5 Due to faster healing time and patient comfort, bandage contact lenses should be considered for initial therapy over the older approach of pressure patching.¹ Contact lenses made of samfilcon A have been shown to be most effective in pain management and re-epithelialization; however, most silicone hydrogel contact lenses are okay to use as bandage contact lenses as they have high oxygen permeability.^2,3 An eye doctor should be consulted before a bandage contact lens is placed on the eye due to the potential for incorrect diagnosis or improper management that could lead to loss of vision. Continued follow up is required to monitor for healing, ensure no infection has occurred, and determine when the contact lens can be removed. Bandage contact lens use should be understood by anyone who may come in contact with caring for a patient undergoing this treatment. Amniotic membranes can be used in lieu of a bandage contact lens, but their use is more specialized to eye care practitioners and their specifics go beyond the scope of this article.³ Future advances in technology such as antibiotic-impregnated contact lenses will further change the way practitioners manage sight-threatening conditions.^3,5

Disclosures

Consultant for Glint Pharmaceuticals.

Statement of Consent

The patient referred to in this video article has given their informed consent to be filmed and is aware that information and images will be published.