|Title||WHITE FIBRILLARY LINES IN THE SUB-EPITHELIAL CORNEA OF A LONG-TERM RIGID CONTACT LENS WEARER: A CASE REPORT|
|Author, Co-Author||Chun-Yee Jenny Lung, Larry Ng|
|Abstract|| BACKGROUND: To report a rare case of asymmetric fibrillary lines within the corneal sub-epithelial layer in a long-term rigid contact lens wearer.
CASE REPORT(S): A 45-year-old high myopic Chinese woman, CH, who had been wearing rigid contact lens (RCL) for more than 20 years, came to our clinic for her RCL replacement. Her current RCL had been used for about three years. The patient reported that her RCL was made of a material with low oxygen permeability material. During her visits for contact lens aftercare consultation, bundles of white fibrillary lines were found on the sub-epithelial layer of the nasal cornea in both eyes. Cornea topography revealed irregular corneal astigmatism in both eyes. The white fibrils were about 5-6 mm long and converged towards the inferior cornea. Negative corneal staining had been observed in both eyes. The patient was asymptomatic, and visual acuity was not affected. The patient had been instructed to discontinue RCL wear, and regular aftercare consultation was arranged for monitoring any progression and/or regression on the fibrillary lines.
The possible etiology, clinical interpretation, management, and differential diagnosis of the white fibrillary lines will be thoroughly discussed in this case report.
CONCLUSIONS: White fibrillary lines were described on normal cornea by Bron (1975) with uncertain etiology. However, the literature shows no previous case reports that describe white fibrils during RCL wear. Their fine nature is easily overlooked by practitioners unless they are viewed using a high-magnification biomicroscope. The author proposes that the existence of fibrils may be due to corneal hypoxia response and mechanical stress by the edge of the RCL on the cornea surface. Further investigation is thus needed in order to more thoroughly understand the clinical significance of the seemingly benign fibrillary changes on the cornea during long-term rigid contact lens wear.
|Affiliation of Co-Authors||The Hong Kong Polytechnic University, School of Optometry|