This patient suffered an acoustic neuroma at age 52. The tumour was successfully excised, but leaving a residual facial nerve palsy with consequent poor lid closure on the right side. The continuous exposure led to gross scarring and vacularisation, and unaided vision of counting fingers.

This guy has Keratoconus

The congenital cataract was removed but following post surgical complications, the eye was left with counting fingers only. Approaching her mid teens, she became more appearance conscious and asked if any non surgical option was available to improve the appearance.

A corneal lens had been worn successfully in the early stages after diagnosis, but gave increasing discomfort as it aggravated a proud epithelial nebula, seen here at the apex of the cornea. A corneal transplant was offered, but the patient declined, preferring to try further contact lens options.

There was a rapid development of a very protrusive globic type corneal profile lead to significant visual loss over a four year period leaving no worthwhile improvement with spectacles. Rigid corneal lens fitting was unsuccessful due to discomfort and instability of the lens in situ. The other eye had developed hydrops, which had more or less resolved, but refitting with contact lenses had been postponed. The profile was much the same as the right eye, having a similar outcome with corneal lenses prior to the hydrops episode.

Clinical History:
Spectacle VA: <6/60
Rigid lens potential VA: 6/24
Fellow eye: nil L/P, wears cosmetic shell.

Contact lens history:
1981. An impression PMMA Scleral lens was issued after recovery from the acute phase. This was worn successfully for 23 years.