What to do when a GP lens wearer after a corneal transplant shows injection and neovascularization at the graft juncture.

A red flag at the graft line: what should a GP fitter do?

If you’re fitting rigid gas permeable (GP) lenses for a patient who just had a corneal transplant, the last thing you want is a quiet day where nothing happens. Unfortunately, sometimes what you see is anything but quiet. In this scenario, a new transplant patient wearing GP lenses presents with injection (redness), edema (swelling), and neovascularization right at the graft junction. The question isn’t just about lens fit—it’s about patient safety and timely collaboration with the surgical team.

Let’s unpack what these signs mean and why the fitter’s first move is so critical.

What those signs are telling you

Injection, edema, and neovascularization at the graft junction aren’t normal aftercare signs, even if the patient has an otherwise long history with contacts. Here’s the gist:

• Injection indicates ocular surface irritation or inflammation. It can be a reaction to contact lens wear, lens-associated hypoxia, or a response to the graft itself.

• Edema around the graft suggests the cornea isn’t balance-centered right now. The cornea loves oxygen, and a lens that traps moisture or reduces oxygen transmission can tip the scale toward swelling.

• Neovascularization at the graft line is especially worrying. New blood vessels near or at the graft can be a sign of rejection or chronic irritation. In a post-transplant eye, that’s a red flag you don’t ignore.

Taken together, these aren’t signals to experiment with a different fit or to tell the patient to push through the discomfort. They’re signals to pause, reassess, and involve the right eyes in the loop.

The right move—and why it matters

The correct action is straightforward in theory: remove the lens and contact the referring practitioner (the surgeon or cornea specialist who performed the transplant). In practice, this approach keeps the eye safer and gives the graft the best chance to recover or stabilize. Here’s the logic in plain language:

• Removing the lens removes a potential source of mechanical irritation. The cornea, especially after a transplant, can be more sensitive to friction, lid interactions, and lens bearing. If the lens is contributing to the problem, taking it off can help the eye settle.

• It allows an accurate assessment. With the lens out, the clinician can observe the surface—the clarity of the graft, the exact extent of edema, and the pattern of any redness—without the confounding effect of the lens.

• It prioritizes specialist input. The cornea team has the full picture: surgical history, current inflammation, and potential rejection risk. A quick report back from the referrer ensures the patient gets appropriate management without delay.

What not to do in this moment

The other options floated in discussions—continuing wear, refitting, or declaring the patient not a candidate—are tempting shortcuts, but they can backfire. Here’s why they’re not suitable in this scenario:

• Continuing with the lens or trying a flatter fit: Pressure or hypoxia from the lens could worsen edema or push inflammatory processes further. A rescue refit sounds reasonable in routine cases, but post-transplant eyes with signs of inflammation deserve caution, not a tweak that might mask a problem.

• Dismissing candidacy for contact lenses: Post-transplant patients can still rely on contact lenses for vision or comfort when cleared by the surgeon. Jumping to a blanket conclusion that they’re not a candidate avoids giving them a path forward and overlooks the need for medical assessment to determine suitability.

• Waiting for symptoms to resolve on their own: That’s a gamble in a grafted eye. Early detection and timely communication with the surgical team can prevent more serious consequences, including graft compromise or more lasting vision loss.

A practical, step-by-step approach for the fitter

When you encounter this scenario, here’s a practical roadmap you can follow. Think of it as a short playbook you can adapt in real time:

1. Stop lens wear immediately. Gently remove the GP lens with proper technique, taking care not to irritate the graft or surrounding tissue.

2. Do a careful, careful exam of the ocular surface. Note the extent of redness, any epithelial defect, the presence of strands or discharge, and the pattern of edema. Document what you see with photos if allowed, while respecting patient privacy.

3. Notify the referring practitioner right away. A quick call or message to the cornea surgeon or the ophthalmologist who did the transplant is essential. Share your observations succinctly: when the signs started, whether they worsened after lens wear, and any symptoms the patient reports (pain, vision changes, photophobia).

4. Advise the patient clearly. Explain why you’ve removed the lens and why you’re seeking the surgeon’s opinion promptly. Provide eye-drop reminders if the clinician has already prescribed a regimen, but avoid offering medical treatments yourself beyond basic comfort measures unless you’re certain of the plan.

5. Prepare for follow-up. The eye may need urgent evaluation, or you may be asked to recheck after a short interval. Keep a record of symptoms, photography, contact events, and any changes in lens status.

6. Safety and comfort guidelines. Instruct the patient on not re-inserting a lens until cleared by the surgeon. If there’s increasing pain, a sudden drop in vision, or a drastic increase in redness, tell them to seek urgent care.

What the surgeon might do next (in a general sense)

Every case is unique, but here’s what tends to happen when a post-transplant eye shows these signs:

• Re-evaluation for graft health. The surgeon will assess for signs of rejection or infection and may opt for topical steroids or antiviral/antibiotic coverage if infection is suspected.

• Lens or contact management decisions. The surgeon may approve temporary discontinuation, adjust the lens modality, or, in some cases, propose a different lens material, design, or wear schedule once the eye has stabilized.

• A clear plan for gradual return. If the graft tolerates it, there will be a staged plan to return to lens wear with close monitoring. That helps protect the graft while restoring visual function.

Why this matters for learners and practitioners

This scenario is more than a test of quick recall. It’s a real-world reminder that corneal health after transplant requires a team approach and careful judgment. For students and professionals who study NCLE content, it highlights:

• Recognizing red flags. A patient wearing GP lenses who presents with redness, swelling, and new blood vessels at the graft line signals risk that demands action beyond a simple fit adjustment.

• The value of collaboration. Eye care doesn’t live in a vacuum. The fitter, the surgeon, and the patient all play a part. Clear communication with the referring practitioner accelerates appropriate care.

• Safety-first decision making. In transplant eyes, the priority is preserving corneal integrity and vision. That often means stepping back from a new lens design or a change in lens wear until the eye is stable.

A few quick reminders you can carry into practice

• Always start with removing the lens when there are signs of inflammation at a graft site, especially in a recent transplant.

• Document and report quickly. Whether you use notes, a photo log, or a quick email, timely information helps the care team act faster.

• Keep the patient informed in plain language. They’re often anxious, and a clear explanation helps them stay cooperative and compliant with the next steps.

• Don’t assume the eye will heal on its own. Post-surgical eyes can flare, and early intervention changes outcomes.

A final thought

If you’ve spent time navigating corneal lens fits, you know the thrill of solving a hard alignment, the satisfaction of a comfortable wear, and the responsibility that comes with any post-surgical case. This scenario is a reminder that the best fit isn’t always a new lens design. Sometimes, the best move is to pause, remove, and connect with the right specialist so the patient has every chance to recover well.

So, when you’re next faced with a post-transplant patient showing redness, swelling, or new vessels near the graft, you’ll know what to do: take off the lens and get the team involved. It’s a small action with a big impact on safety, healing, and future vision. And that’s the kind of patient-centered care that keeps a practice—not to mention a patient—on the path to better days ahead.