Clinical summary

The patient has severe dry eyes, probably associated with a peripheral neuropathic component. This suspicion is supported by a discrepancy between the intensity of the symptoms and the severity of the clinical signs observed. A proparacaine test relieved 90% of his symptoms, suggesting peripheral neuropathic involvement. No signs of superficial punctate keratopathy (SPK) or major conjunctival discolouration were detected. However, grade 3 meibomian gland atrophy was noted in both eyes.

Neuropathic ocular pain may explain severe symptoms in the absence of major clinical signs.

She went through several treatments including IPL sessions, the use of Xiidra, PRGF, and Jett Plasma treatments, and lifestyle adjustments. While IPL provided partial improvement, symptoms persisted, especially in air-conditioned or fresh-air environments. Xiidra has been discontinued due to tolerable but bothersome side effects. The addition of Jett Plasma did not significantly alleviate her symptoms, and the use of artificial tears and hot compresses was maintained to limit discomfort.

PRGF proved to be the only treatment that provided a significant and lasting improvement. In order to optimize its benefits, the decision was made to adapt the patient to scleral lenses by applying PRGF inside the lenses. This approach aims to improve comfort throughout the day and optimize vision, by providing continuous hydration and increased protection of the ocular surface.

Careful monitoring will be continued in order to assess the effectiveness of this strategy and to make any adjustments to maximize the results.