A Case of Atypical Mucin Balls Wearing Extended Wear of Silicone Hydrogel Lens for Therapeutic Use

A 25-year-old man visited our hospital showing atopic conjunctivitis and corneal shield ulcer on his left eye. Although eye drops of 0.1% of betamethasone sodium phosphate and 0.1% of hyaluronic acid ophthalmic solution were prescribed, calcific corneal opacities developed. The corrected visual acuity decreased to 6/20 in Snellen chart. After corneal epithelial exfoliation, removal of calcific corneal opacity was scrubbed with MQA soaked in 0.05？M of ethylenediaminetetraacetic acid (EDTA). After washing the eye with 200？mL of physiological saline, a silicon hydrogel lens, PureVision (balafilcon A), was inserted to obtain pain relief for the therapeutic use. At postoperative day 11, mucin balls were found between cornea and contact lens and stained by rose bengal dye. One of them was atypically larger than usual, and the major axis was approximately 1.5？mm. Wearing lens was stopped, and all of mucin balls and corneal staining were disappeared at postoperative day. Little corneal opacity remained, and visual acuity after surgery recovered to 14/20 at five months. 1. Introduction Silicone hydrogel lenses show very high oxygen permeability. Although its safety and efficacy are well known, the development of mucin balls is reported in extended wearers of silicone hydrogel lenses [1–5]. We report a case with atypical mucin balls during extended wear of silicone hydrogel lens developed after keratectomy for calcific corneal opacities. 2. Case Report A 25-year-old man visited our hospital with ocular pain on the left eye, showing corneal shield ulcer and atopic conjunctivitis. Eye drops of 0.1% of betamethasone sodium phosphate and 0.1% of hyaluronic acid ophthalmic solution were prescribed, but his ocular pain and corneal findings persisted. The corrected visual acuity was 6/20 in Snellen chart at the first visit. At 40 days after the beginning of treatment, calcific corneal opacities developed in the corneal epithelium. Six months after the first visit, the corrected visual acuity decreased to 4/20, and keratectomy was planned to remove calcification in the cornea (Figure 1). Figure 1: Slitlamp microscopic image of a 25-year-old man showing corneal shield ulcer at 40 days after beginning of treatment. After diminishing atopic conjunctivitis and corneal shield ulcer, calcific corneal opacities developed under the corneal epithelium. The operative procedure included corneal epithelial exfoliation over almost the entire cornea using a golf club spud, followed by removal of corneal opacity using MQA (MQA eco-stick, Inami, Tokyo, Japan) soaked in 0.05？M of