Superior epithelial arcuate lesions with soft contact lens wear

Background: Superior epithelial arcuate lesions (SEALs) are an infrequent a nd often asymptomatic complication of conventional soft contact lens wear. The characteristic arcuate pattern of the full-thickness corneal epithelial lesion usually occurs in the area covered by the upper eyelid, within 2 to 3 mm of the superior limbus in the 10- and 2-o'clock region. Methods: Lite rature on SEALs and recent clinical records from clinical trials using two types of prototype high Dk soft contact lenses were reviewed to gain greate r insights into the etiology of SEALs. Results and Conclusions: The reporte d low incidence of SEALs is partly because SEALs are not usually symptomati c. The etiology of SEALs is multifactorial. Our current hypothesis is that SEALs are produced by mechanical chaffing at the peripheral cornea. This ch affing occurs as a result of inward pressure of the upper lid, in an area w here the peripheral corneal topography and lens design, rigidity, and surfa ce characteristics combine to create excessive "frictional" pressure and ab rasive shear force on the epithelial surface. Patient characteristics such as gender, age, and specific corneal and lid topographies also appear to in fluence the occurrence of SEALs. Prototype silicone hydrogel lenses are mad e from higher modulus materials with surfaces that seem to differ subtly in wettability in some patients. The prevalence of SEALs may well increase wi th the first generations of these lenses.