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To describe a case of contact lens–induced vascularized limbal keratitis (VLK) and management with prosthetic replacement of the ocular surface system (PROSE) treatment.Clinical retrospective case report describing the clinical appearance, course of development, and treatment of VLK with PROSE.A 58-year-old white woman presented with a history of advanced keratoconus and almost four decades of contact lens wear, including polymethyl-methacrylate, small-diameter, gas-permeable lenses, low-Dk hybrid, and piggyback lens modalities. Complications of lens wear caused the development of extensive VLK in both eyes, with vascularization, lipid keratopathy, and corneal scarring projecting into the central cornea, more so in the left eye. She was evaluated and treated with PROSE in both eyes, demonstrating initial improvements in both comfort and vision, from 20/30 to 20/25 in the right eye and from 20/40 to 20/20 in the left eye. After 2 years of PROSE treatment, she reported excellent vision and comfort. Acuities were OD 20/25+2 and OS 20/20−/+. There was normalization of the corneal surface with reduced staining and epithelial irregularity, and there was substantial regression of corneal neovascularization and opacity, particularly in the left eye.PROSE, by normalizing the environment at the ocular surface, ultimately improved visual function and long-term ocular health for this patient.