Contact Lens Care & Compliance

Maybe it's Not Dry Eye

By Michael A. Ward, MMSc, FAAO

The symptoms that we associate with ocular dryness are not unique to dry eye. Contact lens wearers may perceive dryness when in fact their symptoms may originate from other causes, including lens material characteristics, lens deposits, tight lens fit, lens care product sensitivities and toxicities, eyelid inflammations, and dehydrating topical and systemic medications. The following case reports illustrate some of these considerations.

Case 1

A 46-year-old male attorney GP lens wearer recently presented for evaluation and management complaining of ocular burning, dryness, fatigue, and foggy vision, which resulted in reduced contact lens wearing time. The symptoms worsened as the day progressed. His symptoms had started insidiously about nine months earlier.

By history he had been a successful GP lens wearer for more than 20 years. The patient reported that his recent eyecare practitioner had suggested that his irritation was due to dry eye and had prescribed artificial tears along with cyclosporine eye drops. The patient also purchased new lenses (Boston XO, Bausch + Lomb [B+L]), which seemed to temporarily lessen his symptoms, but then his symptoms of dryness, burning, and limited wearing time returned. He reported currently using preservative-free artificial tears (PFAT) three to four times a day and was continuing the cyclosporine drops twice a day. He is using a multipurpose GP contact lens care product (Simplus, B+L).

The slit lamp evaluation revealed significant discrete lens deposits and associated non-wetting areas on his GP lens surfaces. The lens fit was adequate. His corneas were clear except for some mild central and paracentral epithelial roughening. It was likely that accumulated lens deposits were causing his symptoms and that the deposition resulted from inadequate lens cleaning through the use of a multipurpose GP lens care product.

We resolved his problem by removing the lens deposits in the office using Progent (Menicon) and changing his lens care regimen to using a daily cleaner (Boston Advance Daily Cleaner, B+L), peroxide disinfection (Clear Care, Ciba Vision), and Simplus for morning lens wetting only. These measures alleviated his symptoms and returned him to full-day wearing time.

Case 2

A 26-year-old female professional golfer presented complaining of persistent dryness and scratchy irritation along with some redness following an initial foreign body episode five months prior. She was told that she has dry eyes and she was currently using PFAT. She was wearing single-use, daily wear soft lenses and was not using any lens care products. Further questioning revealed that she was also using Visine Totality (McNeil) drops four to five times a day, which she has been using since the initial episode.

The slit lamp evaluation disclosed a mild, diffuse, fine corneal punctate staining. She was diagnosed with ocular surface toxicity from the use of preserved (benzalkonium chloride) ocular decongestant (Tetrahydrozoline HCl) eye drops. Her problem resolved after discontinuing the Visine eye drops.

Not Always What You Think

Dry eye is easily over-diagnosed as a reason to discontinue contact lens wear. Be sure to consider other possibilities that may create dry-eye sensations among your lens wearing patients. CLS

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Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service. He is also a consultant to B+L. You can reach him at mward@emory.edu.