The Successful Use of Boston Ocular Surface Prosthesis in the Treatment of Persistent Corneal Epithelial Defect After Herpes Zoster Ophthalmicus

Purpose: To describe the use of the Boston ocular surface prosthesis (BOSP) to successfully treat a persistent corneal epithelial defect (PCED) after herpes zoster ophthalmicus that was minimally responsive to conventional therapies. Methods: A case report. Results: A 44-year-old man who developed a PCED in the right eye after herpes zoster ophthalmicus was treated with conventional therapies, including topical difluprednate opthalmic emulsion, 0.05% cyclosporine ophthalmic emulsion, topical autologous plasma, and oral doxycycline. Silicone plugs were inserted in the right upper and lower puncta. An 18-mm therapeutic hydrogel contact lens was placed in the right eye. After 4 weeks of this treatment, double layer amniotic membrane transplantation and temporary lateral tarsoraphy were performed. Ten days after the procedure, the amniotic membrane had dissolved and the tarsorrhaphy was opened. Because only partial healing of the corneal epithelial defect was observed, the patient was fit with the BOSP that he wore all waking hours. A soft contact lens was worn overnight after the BOSP was removed. Rapid reepithelization was observed within the week after starting the BOSP. The epithelial defect completely healed after 3 weeks, and the uncorrected visual acuity in the right eye improved to 20/50. Conclusions: The BOSP should be considered as an important treatment option for management of PCEDs in eyes with altered corneal sensitivity.