Corneal dystrophies are relatively rare bilateral anomalies. Meesman dystrophy is typically asymptomatic with little effect on visual performance. This case highlights the use of a high modulus silicone hydrogel (SiHy) lens in the management of an atypical presentation of Meesman's dystrophy with associated visual impairment due to epithelial defects. The selection of a SiHy material provided increased oxygenation to re-establish corneal integrity. However, selecting the appropriate modulus was an additional factor to consider in this case since it had a direct effect on the visual outcome. The higher modulus SiHy lenses provided a better visual success for this patient than one with a lower modulus. Modulus consideration may prove to be an additional factor in the lens choice of SiHy in the management of epithelial defects.