A clinical case of fitting scleral contact lenses for congenital bilateral eyelid coloboma complicated by exposure keratopathy
Bibliographic record
Abstract
Introduction. Eyelid coloboma is a rare craniofacial pathology, that usually affects the patient congenitally. Eyelid coloboma in addition to being a cosmetic disfigurement, also affects the cornea, vision and if associated with other systemic abnormalities can cause severe morbidity. Complications of eyelid coloboma are mainly due to corneal exposure from large upper eyelid defects resulting in exposure keratopathy and corneal ulceration if left untreated. The aim of case study: to analyze a clinical case of bilateral upper eyelid coloboma complicated by exposure keratophathy and irregular astigmatism, resulting in low visual acuity in a 4-year-old girl. Description of the case. The patient was born with Manitoba-oculo-trichio-anal (MOTA) syndrome, which was accompanied by bifid nose and eyelid coloboma. The patient had multiple reconstructive surgeries. She was referred to the Miami Contact Lens Institute (MCLI) for Scleral Contact Lens fit (SCL). The examination revealed bilateral acquired infantile corneal opacities of mild density, which occluded the visual axis; complex hypermetropic astigmatism 6.5 diopters; high-grade amblyopia in both eyes -best corrected visual acuity was OD 0.13 and OS 0.05. Scleral contact lenses were fitted to prevent progressive symblepharon, protect the ocular surface, restore vision and to provide comfort due to the severity of dry eye. SCL’s had ideal clearance in the center and at the periphery and provided visual acuity OD 0.2 and OS 0.1. Conclusion. Patients with congenital anomalies are often difficult to treat, especially after multiple reconstructive eyelid surgeries. The mechanical effect of the eyelids on the cornea and the high risk of developing symblepharon and severe amblyopia influenced our decision to fit the patient with SCL. These lenses create a fluid reservoir that provides hydration, comfort, and protection to the exposed surface of the eye and restores vision. Ophthalmologists and pediatricians should pay more attention to the advantages of SCL specifically for patients that require corneal protection from exposure and mechanical damage.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".