Orthokeratology lens wear in lagophthalmos
In this article:
It is not unusual to see someone blink or sleep with incomplete eyelid closure, called lagophthalmos.1 This condition often causes staining across the inferior cornea due to corneal exposure and excessive evaporation of the tear film.1 Here is a case by RS seeking a solution for a child with nocturnal lagophthalmos to help fully close her eyelid whilst sleeping with orthokeratology (OrthoK) lenses.
Corneal staining matters
The corneal condition is important to assess regarding whether a patient is suitable for OrthoK lens wear. If corneal staining is already present before wearing contact lenses, can the staining worsen after OrthoK lens wear? It is common to see mild corneal staining (not more than Grade 2 by Efron grading) after overnight OrthoK lens wear due to lens binding, reduced tear stability or lens decentration.2 This occurs most commonly in the central cornea, typically reaching a maximum in the first few weeks of lens wear and reducing thereafter.3
How can this be managed?
KG and PC reported anecdotally that mild inferior staining can be improved with OrthoK lenses with ocular lubricants acting as a bandage. Carracedo et al and Liu et al found that hyaluronic acid artificial tears provide comfort during OrthoK lens wear and also reduce the incidence of corneal staining.5,6
Take home messages
- Lagophthalmos can lead to corneal staining. This does not preclude a patient from contact lens wear, but it is important to make sure the corneal staining is Grade 1 or below before fitting contact lenses.
- Artificial tears in combination with OrthoK lens wear can improve corneal staining compared to pre-lens wear.
- Closely observe any corneal staining during OrthoK lens wear and ensure good patient lens hygiene compliance to prevent worsening of corneal staining and reduce risk of infection.
Meet the Authors:
About Connie Gan
Connie is a clinical optometrist from Kedah, Malaysia, who provides comprehensive vision care for children and runs the myopia management service in her clinical practice.
About Kimberley Ngu
Kimberley is a clinical optometrist from Perth, Australia, with experience in patient education programs, having practiced in both Australia and Singapore.
This content is brought to you thanks to unrestricted educational grant from
- Fu L, Patel BC. Lagophthalmos. [Updated 2021 Nov 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan. (link)
- Liu YM, Xie P. The safety of orthokeratology-a systematic review. Eye Contact Lens. 2016 Jan;42(1):35. (link)
- Santodomingo-Rubido J, Villa-Collar C, Gilmartin B, Gutiérrez-Ortega R. Orthokeratology vs. spectacles: adverse events and discontinuations. Optom Vis Sci. 2012 Aug;89(8):1133-9. (link)
- Chan B, Cho P, Cheung SW. Orthokeratology practice in children in a university clinic in Hong Kong. Clin Exp Optom. 2008 Sep;91(5):453-60. (link)
- Carracedo G, Villa-Collar C, Martin-Gil A, Serramito M, Santamaría L. Comparison between viscous teardrops and saline solution to fill orthokeratology contact lenses before overnight wear. Eye Contact Lens. 2018 Sep 1;44:S307-11. (link)
- Liu L, Zhong X, Liu H, Chen Y. The influence of three lubricant eye drop on effects and ocular surface of myopia patients after orthokeratology lenses wearing. Chinese J Exp Ophthalmol. 2020:499-503. (link)
Enormous thanks to our visionary sponsors
Myopia Profile’s growth into a world leading platform has been made possible through the support of our visionary sponsors, who share our mission to improve children’s vision care worldwide. Click on their logos to learn about how these companies are innovating and developing resources with us to support you in managing your patients with myopia.