Individuals with quiescent herpes simplex keratitis or herpes zoster ophthalmicus should avoid scleral contact lenses as their use is associated with corneal endothelial dysfunction, according to research published in the Canadian Journal of Ophthalmology.

The investigators of this retrospective study sought to understand the effect of scleral contact lens use on corneal endothelial function in individuals with a history of herpes simplex keratitis or herpes zoster ophthalmicus whose disease was quiescent.

The study included 4 participants who demonstrated corneal endothelial dysfunction after scleral lens use and reported quiescent herpes simplex keratitis or herpes zoster ophthalmicus. The researchers reviewed patient charts for ocular history related to herpes infection, including secondary sequelae, ocular comorbidities, visual acuity, lens prescription, duration of lens use, treatment history, and medication use.

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All participants were treated with antiviral medications and topical steroids; 2 patients required corneal transplantation for definitive treatment related to endothelial dysfunction. The investigators suggested 4 possible etiologies: the fluid reservoir interface of scleral lenses may overwhelm susceptible endothelial cells; a history of herpetic eye disease may increase the susceptibility of endothelial function related to hypoxia from scleral lens use; lens use may independently change morphology of corneal endothelial cells; or scleral contact lenses may aggravate a dormant infection causing herpes endothelial disease to flare up.

Limitations of the study included the small sample size and retrospective nature. However, according to researchers, use of scleral contact lenses by patients with a history of herpes may result in abrupt onset of corneal endothelial dysfunction. Researchers indicated that eye care providers should be aware of this possibility when prescribing scleral contact lenses in this patient population.


Sklar JC, Thakrar V, Sorkin N, Chan CC. Endothelial dysfunction after scleral lens use in patients with herpetic eye diseaseCan J Ophthalmol. [Published online August 7, 2020]. doi: 10.1016/j.jcjo.2020.07.010