A Review of Contact Lens-Induced Limbal Stem Cell Deficiency

Abstract

Limbal stem cell deficiency (LSCD) is a pathologic condition caused by the dysfunction and destruction of stem cells, stem cell precursors and limbal cell niche in the corneal epithelium, leading to severe conjunctivalization of the cornea. Etiologies for LSCD span from congenital (aniridia), traumatic (chemical or thermal injuries), autoimmune (Stevens-Johnson syndrome) and iatrogenic disease to contact lens (CL) wear. Of these, CL wear is the least understood and is often a subclinical cause of LSCD. Even with recent advances in LSCD research, limitations persist in establishing the pathogenesis and treatment guidelines for CL-induced LSCD. A literature search was conducted to include original articles containing patients with CL-induced LSCD. This review will critically discuss the complex pathophysiology behind CL-induced LSCD, the underlying risk factors and epidemiology of the disease as well as methods to obtain a diagnosis. Various treatment options will be reviewed based on proposed treatment strategies.

Keywords: LESC transplantation; contact lens; limbal epithelial stem cells; limbal stem cell deficiency; limbal stem cells.

Figure 1

(a) Slit-lamp images showcasing limbal palisades of Vogt. (b) Zoomed-in view.

Figure 2

Clinical images of patient with CL-induced LSCD. (A,B) Opaque peripheral epithelium in view of invasion of conjunctival tissue with cornea vascularization and pannus formation. (C) Punctate staining in a curve-like path (whorled epithelium).

Figure 3

Bilateral eyes: clinical images of the same patient with CL-induced LSCD. (A,B) Right eye cornea vascularization with fluorescein staining. (C,D) Left eye cornea pannus formation, vascularization encroaching onto visual axis with late fluorescein-staining pattern.