Causes of Corneal Epithelial Injury in Children and Adolescents with Overnight Orthokeratology

Objective: Corneal epithelial injury is one of the common complications on orthokeratology. This article summarizes and analyzes the causes of corneal epithelial injury in children and adolescents who wear orthokeratology lenses overnightfor 6 months continuously, so as to provide relevant reference for better clinical fitting of corneal plastic lenses in the future. Methods: A retrospective analysis was made of 162 children and adolescents (310 eyes) who had been fitted with orthokeratology in our hospital from November 2020 to December 2021. The age ranged from 8 to 17 years old, with an average of 12.45 ± 2.21 years old. The degree of myopia was −1.00~−6.00D, including 67 eyes in Group A (−1.00~−2.00D), 146 eyes in Group B (−2.25~−4.00D) and 97 eyes in Group C (−4.25~−6.00D). The uncorrected visual acuity, anterior surface corneal topography, corneal epithelial fluorescence staining and lens condition of the patients were observed at 1 night, 1 week, 1 month, 3 months and 6 months after wearing orthokeratology lenses. Results: 65 eyes of corneal epithelial injury occurred during 6 months of wearing orthokeratology lenses, including 6 eyes in Group A, 26 eyes in Group B and 33 eyes in Group C. During this period, there were 39, 22, 4 eyes with grade I, II, III corneal epithelial injury, and no grade IV corneal epithelial injury. Corneal epithelial injury occurred in 41 eyes one night after wearing glasses, 13 eyes one week, 3 eyes one month, 3 eyes three months, and 5 eyes six months. Cause analysis of corneal epithelial injury: 26 eyes with mechanical injury, 24 eyes with lens deposits, 6 eyes with bad hygiene habits, 4 eyes with allergic or toxic reaction to nursing solution, 3 eyes with insufficient tear secretion, and 2 eyes with improper lens fitting. Conclusion: Wearing orthokeratology lenses at night may cause corneal epithelial injury in some patients, most of which are mild corneal epithelial injury not exceeding grade II The incidence of corneal epithelial injury above −4.00D is higher, and corneal epithelial injury is more likely to occur when wearing orthokeratol-ogy lenses for one night. Mechanical damage and lens deposit caused by non-standard lens removal and wearing operation are the main causes of corneal epithelial injury.