Therapeutic Scleral Lens Management of Corneal Epithelial Hypertrophy Secondary to a Corneal Persistent Epithelial Defect: A Case Report

A 36-year-old man presented with a vascularized corneal epithelial hypertrophy after a persistent epithelial defect (PED) in the left eye, 1 year after undergoing retinal detachment surgery. Despite multiple interventions such as bandage contact lens, punctal occlusion, topical steroids and lubricants, tarsorrhaphy, amniotic membrane transplantation, and insulin drops, the defect progressed to a hypertrophic, elevated, and vascularized corneal lesion obstructing visual axis. A customized scleral lens (SL) was prescribed to support ocular surface healing, improve comfort, and enhance visual acuity. Over 18 months of daily SL wear, the patient experienced a marked reduction in the size, elevation, and vascularization of the epithelial hypertrophy, with gradual visual improvement from 6/36 to 6/12. The fitting complications, including lens removal difficulty and nasal quadrant impingement, were resolved through edge modification. Follow-up revealed improved ocular surface appearance, a stable fluid reservoir, and better surface wettability. This case highlights the therapeutic potential of SLs not only in promoting epithelial healing but also in remodeling chronic corneal pathologic condition such as epithelial hypertrophy and neovascularization post-PED. Scleral lens therapy, when appropriately customized and monitored, offers a safe, nonsurgical alternative for patients with complex ocular surface disorders unresponsive to conventional treatments.