A 13-year-old Romanian boy presented to the eye clinic with a chief complaint of blurred distance and near vision. The patient reported a history of a boil on his neck that was removed in Russia one year ago. Cover testing demonstrated bilateral end point nystagmus and exotropia. Ocular health evaluation revealed an astrocytic hamartoma and oculo-rotary nystagmus. Referral to a retinal specialist helped confirm the diagnosis of astrocytic hamartoma but did not elucidate on the possible aetiology of the lesion or rule out tuberous sclerosis as the causative agent, as the patient was lost to follow-up. Based on fundus signs along with the nystagmus, neuro-imaging studies are indicated to rule out any intracranial masses that may be present. The most important differential diagnosis that must excluded is retinoblastoma, which can closely resemble astrocytic hamartoma. The suspicion of tuberous sclerosis was also considered as a potential cause of the retinal lesion, based on clinical signs. The prognosis for astrocytic hamartomas is relatively good, although until tuberous sclerosis is ruled out, caution should be exercised and serial ophthalmic evaluations should continue.

Purpose: To investigate the short-term impact of scleral lens wear on intraocular pressure (IOP) and retinal nerve fiber layer thickness (RNFL). Methods: This prospective study included 31 healthy participants aged 26 ± 3 years who were randomly fitted with a 16.5 mm scleral lens over one eye and a soft contact lens on the other eye. IOP and RNFL thickness were examined at baseline in the morning and following 8 hours of scleral and soft contact lens wear in the evening. Two tonometers (a transpalpebral Diaton and a non-contact tonometer) were used to measure IOP. Measurements of IOP and RNFL were taken under four different conditions: pre- and post-lens application, and pre- and post-lens removal. Results: Eyes fitted with a scleral lens exhibited a significant increase in IOP (pre-application: 11± 3 mmHg vs. post-application: 16 ± 4 mmHg, P < 0.001) immediately after scleral lens application, and the increase in pressure was sustained throughout the 8 hours of lens wear (pre-removal IOP: 16 ± 4 mmHg). IOP returned to baseline after scleral lens removal (11 ± 3 mmHg). Eyes fitted with soft contact lenses did not show significant IOP changes under any condition (P >0.05). Eyes with a scleral lens also showed a small but significant thinning of peripapillary RNFL (pre-application: 110 ± 11 µm vs. post-application: 107 ± 11 µm, P < 0.001) after 8 hours of lens wear, which was not significant with soft contact lens wear (P > 0.05). IOP data obtained from Diaton showed poor within-participant variation and poor agreement compared to IOP data from the non-contact tonometer. Conclusion: This study suggests that short-term scleral lens wear may significantly raise IOP and cause transient peripapillary RNFL thinning, which returns to baseline immediately following lens removal. Monitoring IOP and RNFL is recommended for scleral lens wearers, with future research needed to assess the long-term effects.

Purpose: To investigate the short-term impact of scleral lens wear on intraocular pressure (IOP) and retinal nerve fiber layer (RNFL) thickness. We hypothesized that scleral lens wear would produce a measurable elevation in IOP accompanied by detectable RNFL thinning compared with soft contact lens wear. Methods: This prospective, randomized, contralateral-eye crossover study included 31 healthy participants (mean age: 26 ± 3 years). Each participant wore a 16.5 mm scleral lens over one eye and a soft contact lens over the fellow eye for 8 h, with assignments reversed between visits. IOP was measured using two tonometers: a transpalpebral Diaton tonometer and a non-contact tonometer (NCT), and RNFL thickness was measured by optical coherence tomography at four time points: pre- and post-lens application, and pre- and post-lens removal. Results: Eyes fitted with scleral lenses exhibited a significant IOP increase immediately after lens application (pre-application: 11 ± 3 mmHg vs. post-application: 16 ± 4 mmHg, p < 0.001), sustained throughout 8 h of wear (pre-removal: 16 ± 4 mmHg), and returned to baseline after removal (11 ± 3 mmHg). No significant IOP changes were observed in soft contact lens-wearing eyes (p > 0.05). Scleral lens wear was also associated with small but statistically significant peripapillary RNFL thinning (pre-application: 110 ± 11 µm vs. post-application: 107 ± 11 µm, p < 0.001), which returned to baseline after lens removal. No significant RNFL changes were observed with soft contact lens wear (p > 0.05). Bland–Altman analysis revealed poor agreement between Diaton and NCT measurements, consistent with the published literature on transpalpebral tonometry. Conclusions: Short-term scleral lens wear was associated with transient IOP elevation and peripapillary RNFL thinning, both reversible upon lens removal, in healthy young adults. These findings highlight the need for further longitudinal investigation in at-risk populations such as those with ocular hypertension, keratoconus, or early glaucoma before clinical monitoring recommendations can be established.