Contact Lens-Related “Keratoschisis”—An Unusual Case of Corneal Stroma Lamellar Trauma

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Abstract

Purpose:

To describe the clinical, imaging, and histopathological features of a highly unusual, postcontact lens removal scenario in a 29-year-old woman. Most documented cases recover good vision but differ significantly from our case.

Methods:

A 29-year-old woman presented to the Eye Casualty Department as she was unable to remove her right soft contact lens after having inadvertently slept wearing soft contact lenses. During removal, extensive axial corneal epithelial sloughing occurred. Examination immediately after lens removal revealed keratitis and hypopyon, and she was administered intensive topical antibiotics. During her treatment course, a raised crescent of edematous tissue was noted centrally. This persisted at 6 weeks after presentation, so exploration under anesthesia and superficial keratectomy were performed. The preoperative optical coherence tomography (OCT) image showed a thickened inferior cornea with a “tent” of epithelium growing over it. The operative findings identified a flap of the cornea, reflected back on itself and a corresponding stromal depression superior to the flap, correlating well with the OCT findings. The flap was removed and sent for histopathological examination.

Results:

Histology revealed stromal tissue without the Bowman layer. The corneal stroma was scarred and chronically inflamed. Immunohistochemistry for pan-cytokeratins revealed epithelial cells on both sides of the flap, confirming that regenerative epithelial hyperplasia had occurred over the stromal flap and concurring well with the “tent” of epithelium observed on the OCT.

Conclusions:

We have described a highly unusual case of an inferiorly displaced stromal lamellar corneal traumatic flap associated with a soft contact lens removal, which we have termed lens-associated keratoschisis.

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