Pediatric and Teen CL Care

When Teen Patients Have Dry Eyes, Check Their Medications

By Mary Lou French, OD, MED, FAAO

July is the Dry Eye Issue of Contact Lens Spectrum. It is a rare child who has dry eyes; occasionally I will have young patients complain of dryness, but most often it is related to allergies or to lack of a better term for a sandy, gritty feeling related to conjunctivitis.

Teens and Medication Use

However, teens compose probably the largest group of contact lens wearers in my practice, perhaps in yours, too. And, what are teens most subject to? Acne. Depending on the severity of the condition, they may require medication to control the outbreaks and to treat the acne.

Many medications are prescribed in the treatment of acne vulgaris; among them are doxycycline, minocycline, and isotretinoin. The first two do not create any adverse side effects with contact lens wear, nor do they create dry eye symptoms or meibomian gland dysfunction impacting contact lens wear.

The last medication on the list is the generic name for the brand Accutane, which is no longer prescribed in the United States but is still available in the generic form. Isotretinoin is generally reserved for more severe, unresponsive cases of acne. A recently published article (Neudorfer et al, 2012) cites that 14 percent of isotretinoin patients had ocular adverse events, ranging from ocular side effects of conjunctivitis to contact lens intolerance, dry eyes, and some reports of blepharitis.

Over the past year, and as recently as last month, I have seen a few patients who are on this medication. When my teen patients, especially my more compliant ones (I do have some!), present with dry eyes, contact lens intolerance, and red eyes, and there aren't any obvious signs of the usual causes such as sleeping in lenses, contact lens overwear, etc., then I go to the change in medication list.

Some gender issues are also related to the medication listing. A more well-known pharmacological reason for contact lens intolerance is birth control pills (BCPs). A random check of the most commonly prescribed BCPs list contact lens intolerance as a side effect, but those are milder effects relative to the isotretinoin.

Daily Disposables a Saving Grace

When their symptoms interfere with wearing contact lenses, the toughest recommendation I have to make to these teens is to discontinue wearing their contact lenses and to wear their glasses for however long it takes to treat the dry eye issues or conjunctivitis. But any length of time is often too long for some of these patients for whom the social and esteem issues can be painful.
Already suffering with severe acne, many also wearing braces, and then being forced into wearing glasses can bring back shades of our own growing up years.

Daily disposable lenses have tremendously improved my ability to help these patients, especially with the advent of daily disposables for astigmatism. Being able to fit all of my patients—not just the spherical lens wearers—with a daily disposable lens is an asset to the medical side of my practice as well as to the contact lens side.
Now teen patients can safely wear contact lenses during treatment of their vision issues at least part of the time for school, sports, or special events, without compromising the treatment regimen or their self-esteem. Helping them maintain their self-esteem, even just for part of their day, is to me as important as the treatment itself is. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #200.