A rigid gas-permeable lens wearer presents with punctate staining and mild erosion confined to the inferior peripheral cornea at the 3 o'clock and 9 o'clock positions. The most appropriate intervention is:

• A Start topical cyclosporine 0.05% twice daily and continue the same wearing schedule unchanged
• B Refit immediately with a much steeper base curve to lift the lens off the limbus
• C Improve lens wettability, review blink completeness and consider a thinner or better-edge-design lens with lubricating drops ✓
• D Prescribe topical steroid drops and extend wearing time to build tolerance

Explanation

Three and nine o'clock staining is a classic RGP complication caused by poor wetting and inadequate blinking at the nasal and temporal peripheral cornea where the lid loses contact with a thick, poorly wetting lens edge. Management targets lens material water content, edge design and thickness plus lubricants and blink training. Steepening the fit does not address the mechanism, steroids are not indicated for mechanical staining, and extending wear would aggravate hypoxia and desiccation.

Reference: Krachmer, Cornea: Fundamentals, Diagnosis and Management, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.