Orthokeratology as a treatment option for nocturnal lagophthalmos

Purpose: Dry eye is a very common disease in the population with different subjective and objective symptoms. A detailed medical history plays an important role in the determination of the causative factor. This case report describes the treat ment of a patient with nocturnal lagophthalmos by fitting orthokeratology contact lenses.

Material and Methods: The dry eye analysis was performed using the SOAP (Subjective, Objective, Analysis, Plan) format. The medical history taken using the OSDI (Ocular Surface Disease Index) questionnaire was helpful in this context. In addition, detailed clinical findings were recorded. This was done on the basis of a standardized procedure according to the Dry Eye Workshop (DEWS II) of the Tear Film and Ocular Surface Society (TFOS). Based on the morning symptoms and clinical findings, nocturnal lagophthalmos was suspected and orthokeratology contact lenses were fitted for visual and clinical rehabilitation.

Results: With orthokeratology the patient was nearly asymp tomatic with a monocular visual acuity of 20/20 per eye. The bulbar conjunctival hyperemia and corneal stainung were sig nificantly reduced and remained stable even after two years. The OSDI score decreased from 89 to 27, which corresponds to moderate dry eye.

Conclusion: Patients with clinically normal eyes and subjec tively severe dryness symptoms represent a major challenge in optometric practice. A detailed medical history is important in this context. In this specific case, the morning symptoms were the key to successful treatment of the patient. Ortho keratology can be an interesting method of simultaneously treating two clinical findings in a case of nocturnal lid retrac tion. On the one hand, the contact lens protects the cornea from drying out to a certain degree overnight, and on the other hand, the myopia can be corrected without wearing contact lenses during the day