Does Wearing Scleral Lenses Increase Eye Pressure in Patients with Corneal Injuries?

Q: Does Wearing Scleral Lenses Increase Eye Pressure in Patients with Corneal Injuries?

Hello： Regarding your question, based on your medical history, here are a few suggestions： <br>1. <br>Corneal injury may affect intraocular pressure measurement： Yes, sometimes irregularities in the cornea (such as scars or protrusions, like keratoconus) can influence the measure

Does wearing a scleral lens increase intraocular pressure?

Hello Doctor, due to an injury to my cornea when I was five years old, I underwent corneal suturing and the placement of an artificial lens.
In May 2023, I had my intraocular pressure checked in both eyes, and the doctor said the pressure was normal.
In August of the same year, I started wearing a scleral lens to correct the irregular astigmatism in the injured eye.
However, in December of the same year, when my eye pressure was measured, the left eye showed a normal pressure of 19, while the right eye (the injured one) had a higher pressure reading of 22.
The doctor conducted further optic nerve imaging, which indicated that the nerve was fine, and advised me to follow up in a month.
I would like to ask the doctor: 1.
If my cornea is sutured and somewhat protruding, similar to a cone, could this cause a higher intraocular pressure reading? 2.
I have read that individuals who have undergone eye surgery are considered to be at higher risk for glaucoma.
Since I had surgery 25 years ago due to corneal and lens injuries (when I was five, the doctor placed an artificial lens through the perforation and sutured my cornea, and as far as I remember, the sclera was not incised), is it still possible, after 25 years, for my previously injured eye to develop glaucoma due to the prior trauma?

Mr. Mai, 30~39 year old female. Ask Date: 2024/01/02

Dr. Gao Pilin reply Ophthalmology

Hello: Regarding your question, based on your medical history, here are a few suggestions:
1.
Corneal injury may affect intraocular pressure measurement: Yes, sometimes irregularities in the cornea (such as scars or protrusions, like keratoconus) can influence the measurement of intraocular pressure.
This may result in falsely elevated readings due to the shape of the cornea.
However, this does not necessarily indicate the presence of glaucoma and requires further evaluation.
2.
Eye surgery and glaucoma risk: Your history does include eye surgery, which is a potential risk factor for increased glaucoma risk.
However, the development of glaucoma is not inevitable, and not all patients who undergo eye surgery will develop glaucoma.
Close monitoring and regular ophthalmic examinations are necessary to ensure the health of your eyes.
3.
Regular follow-up and examination are key: For abnormal intraocular pressure readings, your medical team has taken the appropriate steps and conducted further optic nerve imaging.
This is to ensure the health of the optic nerve and to better understand the implications of the intraocular pressure readings.
Follow-up examinations are crucial, as they help the physician determine if there are any conditions that require further intervention.

Reply Date: 2024/01/02

More Info

Wearing scleral lenses can indeed have implications for eye pressure, especially in patients with a history of corneal injuries. Your situation is quite complex, given your past corneal surgery and the recent changes in your intraocular pressure (IOP). Let's break down your concerns.

1. Impact of Corneal Shape on Eye Pressure Measurement: The shape of your cornea, especially if it has been altered due to previous surgery or injury, can affect the accuracy of eye pressure measurements. In cases where the cornea is irregular or has scarring, such as in keratoconus or post-surgical changes, the tonometry readings may not reflect the true intraocular pressure. This is because the cornea's biomechanical properties are altered, which can lead to falsely elevated or decreased IOP readings. Therefore, if your cornea is more protruded or irregular, it could potentially lead to a higher measured IOP, even if the actual pressure within the eye is normal.

2. Risk of Glaucoma Post-Surgery: You are correct in noting that individuals who have undergone eye surgery, particularly those involving the cornea or intraocular structures, may be at an increased risk for developing glaucoma. This risk is not solely due to the surgery itself but can also be influenced by other factors such as the healing process, the presence of scar tissue, and changes in eye anatomy. While it is not guaranteed that you will develop glaucoma, it is essential to monitor your eye health closely, especially given your history of corneal injury and the recent elevation in IOP in your right eye.

3. Monitoring and Follow-Up: Given that your eye pressure was measured at 22 mmHg in the right eye, which is above the normal range, it is crucial to follow up with your ophthalmologist. They may recommend additional tests, such as visual field testing or optical coherence tomography (OCT), to assess the health of your optic nerve and to rule out any signs of glaucoma. Regular monitoring is vital, as early detection and management of elevated IOP can prevent potential vision loss.

4. Scleral Lenses and Eye Pressure: Scleral lenses are designed to vault over the cornea and rest on the sclera, creating a tear-filled reservoir that can provide comfort and improved vision for patients with corneal irregularities. While scleral lenses themselves do not directly cause an increase in eye pressure, they can contribute to discomfort or complications if not fitted correctly. If the lenses are too tight or if there is inadequate tear exchange, this could potentially lead to issues that might indirectly affect eye pressure.

5. Conclusion: In summary, while scleral lenses can be beneficial for managing corneal irregularities, they may also complicate the assessment of eye pressure in patients with a history of corneal surgery. It is essential to maintain regular follow-ups with your eye care provider to monitor your IOP and overall eye health. If you experience any new symptoms, such as pain, vision changes, or increased redness, you should seek immediate medical attention. Your proactive approach to understanding your condition and seeking clarification is commendable and will aid in maintaining your ocular health.

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