This article has Open Peer Review reports available.
Migration of rigid gas permeable contact lens into the upper eyelid after trauma: a case report
© Kang et al. 2016
Received: 27 August 2015
Accepted: 21 May 2016
Published: 1 June 2016
Migration of a rigid gas permeable (RGP) contact lens after trauma is rare, and its clinical characteristics have not been fully discussed.
A 36-year-old female showed mild swelling in the right upper eyelid. She lost her RGP contact lens seven months prior to her first visit, from trauma by her child’s kick to the right eye. At the first examination, we felt a firm lump inferior to the right brow. Eversion of the upper eyelid also revealed a firm subconjunctival mass superior to the upper tarsus. After incising the conjunctiva, the RGP contact lens was found without a fibrous capsule and granulation tissue in the subconjunctival space. Three years after removal of the lens, the patient did not show any complications, including ptosis.
The RGP contact lens in the present case migrated into the subconjunctival space superior to the upper tarsus without a fibrous capsule and granulation tissue. These findings are similar to those in previously reported traumatic cases but are different from those in some spontaneous migration cases. This difference may be caused by differences in the migration mechanisms.
KeywordsRigid gas permeable contact lens Migration Trauma Subconjunctival space fibrous capsule Granulation tissue
Contact lens migration was first reported in 1963 , followed by approximately 50 reported cases . The majority of cases exhibited spontaneous migration , while a traumatic migration was rare and only three traumatic cases had been reported [3–5]. The site of migration was variable, including the upper fornix, intra-tarsus, preseptal space, and intra-orbit . Most patients remained asymptomatic for a certain period, but later occasionally complained of chronic irritation, mucous discharge, eyelid swelling, and mechanical ptosis [2, 6].
Here, the following case presents a rare case of a rigid gas permeable (RGP) contact lens migrating to the upper eyelid after trauma.
Institutional Review Board approval from the Ethics Committee at Aichi Medical University was obtained (No. 15–033), and the tenets of the Declaration of Helsinki were followed. The patient gave informed consent prior to inclusion in the study. Written informed consent was obtained from the patient for publication of this case report and any accompanying images.
A 36-year-old female complained of right upper eyelid swelling. She lost her RGP contact lens 7 months prior to her first visit from trauma by her child’s kick to the right eye. She did not have a prior history of any ophthalmic disease.
Similar case reports with migration caused by trauma have been reported, with all sites involving the subconjunctival space above the upper tarsus [3–5]. However, previous reports of spontaneously migrating contact lenses described a variety of migration locations, such as the intra-tarsus, preseptal space, and intra-orbit . A contact lens simply penetrates the conjunctiva in traumatic cases; in contrast, chronic abrasion of periocular tissue by a contact lens induces local necrosis or abscess in spontaneous cases [2, 9]. Periocular tissue disruption may cause migration into hard tissues or deeper spaces in spontaneous cases.
In the present case, no fibrous capsule or granulation tissue was seen around the migrated RGP contact lens. This finding is similar to previous reports of traumatic cases [3–5]. However, capsule and/or granulation tissue have been found in most spontaneous migration cases . Traumatic cases show less tissue disruption during the migration process than spontaneous cases. This difference may be associated with variations in the severity of the inflammatory responses in the periocular tissue around the migrated contact lenses.
In conclusion, this case report describes a rare case of RGP contact lens migration resulting from trauma to the upper eyelid fornix. Clinical findings may differ between traumatic and spontaneous cases because of differences in the migration mechanisms.
RGP, rigid gas permeable
No one contributed to the work that did fit the authorship criteria.
Availability of data and materials
All the data supporting our findings is contained within the manuscript.
All authors qualify for authorship based on contributions to conception and design (YN, HiK), acquisition of data (YT), and analysis and interpretation of data (HyK, YT, HiK). All authors contributed to drafting the article, revising it critically for important intellectual content, and final approval of the version to be published.
The authors declare that they have no competing interests.
Consent for publication
Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the editor of this journal.
Ethics approval and consent to participate
Institutional Review Board approval from the Ethics Committee at Aichi Medical University was obtained (No. 15–033), and the tenets of the Declaration of Helsinki were followed. Written informed consent was obtained from the patient for participating in this study.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Green WR. An embedded (“lost”) contact lens. Arch Ophthalmol. 1963;69:23–4.View ArticlePubMedGoogle Scholar
- Watanabe A, Sun MT, Selva D, Ueda K, Wakimasu K, Kinoshita S. Two presentations of upper lid migration of rigid cag-permeable lenses. Eye Contact Lens. 2012;38:336–40.View ArticlePubMedGoogle Scholar
- Nicolitz E, Flanagan JC. Orbital mass as a complication of contact lens wear. Arch Ophthalmol. 1978;96:2238–9.View ArticlePubMedGoogle Scholar
- Chappell Jr JJ. Contact lenses in the upper eyelid masquerading as lid masses. Ophthalmic Surg. 1987;18:851.PubMedGoogle Scholar
- Shenken S. Traumatic dislocation of a contact lens into the eyelid. Can Med Assoc J. 1969;101:295–6.PubMedPubMed CentralGoogle Scholar
- Zola E, van der Meulen IJE, Lapid-Gortzak R, van Vliet JMJ, Nieuwendaal CP. A conjunctival mass in the deep superior fornix after a long retained hard contact lens in a patient with keloids. Cornea. 2008;27:1204–6.View ArticlePubMedGoogle Scholar
- Nema HV, Nema N. Injuries to the eye. In: Nema HV, Nema N, editors. Textbook of Ophthalmology. 6th ed. New Delhi: Jaypee Brothers Medial Publishers; 2012. p. 359–60.View ArticleGoogle Scholar
- Khan IJ, Ghauri AJ, Hodson J, Edmunds MR, Cottrell P, Evans S, et al. Defining the limits of normal conjunctival fornix anatomy in a healthy South Asian population. Ophthalmology. 2014;121:492–7.View ArticlePubMedPubMed CentralGoogle Scholar
- Bock RH. The upper fornix trap. Br J Ophthalmol. 1971;55:784–5.View ArticlePubMedPubMed CentralGoogle Scholar