Introduction: Amniotic fluid (AF) solutions are acellular formulations of proteins, cytokines, and growth factors isolated from human amniotic fluid. AF is indicated for keratoconjunctivtis sicca to promote healing of the ocular surface.
Case Report: A 48-year-old healthy Asian female complained of long-standing contact lens (CL) intolerance with noticeable deposits after 5 hours of wear. Her ocular history is significant for use of rigid gas permeable (Boston ES) CLs for 30 years, and use of numerous non-preserved artificial tears and omega-3 fish oils without improvement in symptoms. Examination showed no signs of aqueous or lipid deficiency, but severe symptoms accompanied by tear film instability and patchy corneal and conjunctival staining suggested presence of mucin deficiency. Tear-aqueous quantity was normal by tear meniscus (0.26,0.28 mm OD,OS) and Schirmer’s I (12,14 mm OD,OS). Tear-lipid thickness (TLT), meibomian gland expression, and meibography were normal. However, coalesced corneal staining (fluorescein) and conjunctival staining (lissamine green) were accompanied by short tear breakup times (TBUTs): 1.74 sec OD, 2.89 sec OS with fluorescein and 5.23 sec OD, 3.94 sec OS with Medmont. Regener-Eyes® AF ophthalmic solution was recommended twice daily to facilitate ocular surface healing. Corneal staining resolved after 19 days. The severity of conjunctival staining, although markedly improved after 19 days, had subsided to mild after 49 days. TLT increased 20 days after treatment while TBUT remained unchanged. Patient reported mild improvement in dryness symptoms but continued to notice lens deposits impeding vision after 5 hours of lens wear.
Conclusion(s): Regener-Eyes® appears to be effective at healing the ocular surface after approximately 3 weeks of treatment. Our goal is to follow this patient over the next 6 months and consider alternative treatments targeting mucin production to improve tear film stability.