Corneal prolapse will present as loose conjunctival tissue suctioned in underneath the scleral lens bowl.
This will happen when the lens has too little sagittal height in that meridian causing insufficient down pressure of the SLZ on the sclera. With insufficient down pressure tears will flow in underneath the lens, dragging loose conjunctival tissue in with it.
With OCT imaging the loose conjunctival tissue has a rounded ‘wave-like’ appearance.
To confirm if the insufficient sag is present, perform an over topography and a negative fluorescein test. With insufficient down pressure, the over topography will show a minus cylinder and sodium fluorescein will readily flow in underneath the lens bowl in the same meridian as the observable corneal prolapse.
With the positive confirmation of insufficient corneal sag, using the over topography and negative fluorescein tests, increase the sagittal height of the lens in that meridian until sufficient down bearing of the SLZ is achieved.