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Optom Vis Sci. 2022 Jan 07; doi: 10.1097/OPX.0000000000001860. Epub 2022 Jan 07.

Case Report: Intracorneal Hemorrhages Seen with Scleral Contact Lens Wear and Netarsudil Therapy.

Optometry and vision science : official publication of the American Academy of Optometry

Amanda R Crum, Divya Srikumaran


  1. Department of Ophthalmology, Johns Hopkins Medicine | Wilmer Eye Institute, Odenton, Maryland (both authors).

PMID: 35001067 DOI: 10.1097/OPX.0000000000001860


SIGNIFICANCE: Intracorneal hemorrhages are a rare finding generally associated with surgery or trauma. There is no consensus on preferred management except eliminating or addressing the causative mechanism in hopes of reducing the risk of corneal haze or scarring.

PURPOSE: This case highlights a rare adverse outcome of intracorneal hemorrhages occurring after recent initiation of netarsudil, possibly exacerbated by scleral contact lens wear in a patient with open-angle glaucoma and limbal stem cell deficiency.

CASE REPORT: A 77-year-old male using scleral contact lenses for therapeutic management of limbal stem cell deficiency started netarsudil for open-angle glaucoma. During an annual follow-up to adjust his scleral contact lenses, the patient developed peripheral intracorneal hemorrhages bilaterally. The intracorneal hemorrhages resolved over the course of ten weeks after minor adjustments were made to the scleral contact lens fit and netasurdil was discontinued. Visual acuity and intraocular pressure remained stable throughout.

CONCLUSIONS: There are few reports of intracorneal hemorrhages associated with scleral contact lens use and even fewer associated with the use of netarsudil. This case proposes several possible causes of the intracorneal hemorrhages, including topical rho-associated kinase inhibitors, contact lens wear, and trauma. Further studies are needed to determine if netarsudil is associated with intracorneal hemorrhages, to understand the sequelae of intracorneal hemorrhages in netarsudil therapy, and to recommend management when intracorneal hemorrhages manifest with netarsudil use.

Copyright © 2022 American Academy of Optometry.

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