Epithelial inclusions in association with mucin ball development in high-oxygen permeability hydrogel lenses

Debris trapped behind contact lenses may be associated with adverse reactions in extended wear. Although streaks and clumps of cellular material have been reported after overnight wear of conventional materials, recent experience with several high-oxygen permeability (Dk), silicone-containing hydrogel lenses indicates that certain participants are prone to the development of a unique back surface debris. This debris forms as spherical, translucent entities and results in depressions within the ocular surface after lens removal. Little information is known about these spherical bodies, particularly with respect to their composition and development. In this report, we provide photographic evidence of this debris (sometimes termed mucin balls or lipid plugs), discuss its differential diagnosis and describe a case in which material seems to be embedded in the epithelium as a direct consequence of their presence.