Bandage Contact Lenses
Bandage Contact Lenses
Bandage contact lenses can protect the eyes and increase comfort for patients with damaged or compromised corneas.
By William B. Trattler, MD
When patients present with corneal damage due to injury or disease, bandage contact lenses can promote healing and reduce discomfort. Bandage contact lenses not only protect the eye from external assault, they also isolate the corneal surface from friction during blinking. Additionally, unlike other protective methods, such as pressure patching, bandage contact lenses allow medication to be easily instilled.
Designed to speed healing and protect a compromised ocular surface or cornea, therapeutic contact lenses have been available for some time. In recent years, some soft cosmetic contact lenses—both daily and extended wear—have also become FDA-approved for therapeutic use. Made of silicone hydrogel materials that allow for a high degree of oxygen transmission, these lenses are now available in plano power for therapeutic purposes.
Over the past few years, I have used the Acuvue® Oasys™ brand as bandage contact lenses, and our Center was part of the study that led to the FDA approval of this lens for thereapuetic use in 2007. The lens is extremely comfortable for patients (in both therapeutic and cosmetic wear), and patients with mild to moderate dry eye are candidates for this lens technology as it is made of a highly wettable material. An additional benefit is the lens’ UV-blocking properties, as it blocks up to 86% of UVA and almost 100% of UVB. I still remind my patients to wear sunglasses outside, however, as I practice in south Florida where there is the potential for high levels of UV exposure.
Uses and Indications
Bandage contact lenses are essential for ablative procedures like PRK and PTK. Following these procedures, bandage contact lenses provide a protective environment to help speed epithelialization, as well as reduce pain and ocular surface irritation. I place a bandage lens on the eye immediately after surgery and instruct the patient to leave it in until I remove it at a follow-up visit 4 to 5 days postoperatively.
In addition to excimer laser surgery, I use bandage contact lenses for virtually any type of abrasion or recurrent corneal erosion. Bandage lenses can significantly reduce discomfort and can help with reepithelialization. Other conditions for which I commonly use bandage contact lenses, and for which Acuvue® Oasys™ lenses are indicated, include bullous keratopathy and filamentary keratitis.
As useful as soft bandage contact lenses may be, there are situations in which they are contraindicated. I am, for example, careful not to use them on eyes that are so dry that the bandage lens might further irritate the ocular surface. In these cases a rigid scleral lens that vaults over the cornea without touching it is usually a better option.
Bandage contact lenses are, in my opinion, superior to other protective options (eg, pressure patches) in one respect: with bandage lenses patients can easily instill eye drops. Bandage lenses may also potentially act as a reservoir for topical medications, increasing the amount of time a medication stays in contact with the eye.
Antibiotic prophylaxis is needed any time a bandage contact lens is used over a corneal abrasion or erosion and whenever one is used postoperatively. For an abrasion or erosion, a fluoroquinolone can be given 3 or 4 times a day, depending on the fluoroquinolone used. Likewise, after PRK or PTK, patients need to use topical antibiotics and nonpreserved artificial tears on a frequent basis.
After placing bandage lenses, I counsel patients to call the office immediately if there are signs or symptoms of corneal infection (eg, pain, reduction of vision, photophobia, etc.). Despite using prophylaxis, it is important to remain vigilant for signs of infection, as infection can lead to corneal scarring and vision loss.
THE BOTTOM LINE
Bandage contact lenses promote healing, serve as a protective barrier, and reduce discomfort in eyes that have been ablated, have a corneal abrasion or erosion, or have conditions such as bullous keratopathy or filamentary keratitis. I use Acuvue® Oasys™ contact lenses, which have excellent oxygen transmissibility and are FDA approved for therapeutic use. Eyes that have had surgery or which have an erosion or abrasion require antibiotic prophylaxis to prevent infection. Unlike other protective options, bandage contact lenses allow for easy drop instillation.
William B. Trattler, MD, is director of cornea at the Center For Excellence in Eye Care in Miami, FL. Refractive Eyecare associate editor Diana Friedman assisted in the preparation of this manuscript.