A 36-year-old male wearing spherical daily disposable contact lenses for myopia correction came in for his yearly exam. At his last visit, he was happy with his current lenses from both a comfort and a vision perspective. This year, he reported that although the vision seemed good with the contact lenses, he “notices the lenses” more frequently. He feels that he is taking them out in the evening earlier than he would like. He also reported that contact lens rewetting drops, used when the lenses become uncomfortable, help extend the wear of the lenses.

Anterior segment examination was remarkable for mild deposits and a visible volcano sign at the base of the lashes. The volcano sign results from the edematous follicular tissue swelling up around the base of the lash. The meibomian glands seemed normal, with good structure and function (Rynerson and Perry, 2016). The conjunctiva and cornea were clear. Matrix metalloproteinase-9 testing showed a trace positive finding (Brujic and Kading, 2016) for both the right and left eye.

Lid Margin Inflammation

Rynerson and Perry (2016) published a paper on dry eye blepharitis syndrome (DEBS), a unification theory in which dry eye is a continuum of chronic blepharitis. They stated that, over time, biofilms form on the lid margin; this increases the concentration of bacteria, eventually leading to bacterial virulence factors being secreted that cause the localized inflammation.

Over time, as the biofilm continues to increase and migrate posteriorly, it can affect the meibomian glands. Initially, this appears as non-obvious meibomian gland dysfunction, causing gland obstruction without any visible changes to the glands. As the biofilm continues to occupy the gland in greater quantities, it leads to more inflammatory sequelae that will ultimately lead to obvious meibomian gland dysfunction (Rynerson and Perry, 2016). Eventually, the inflammation that results will lead to alteration of the lid architecture including serrated lid margins, lid laxity, entropion, and ectropion.

How This Affects Lens Wear

A recent study examined contact lens wearers for comfort during lens wear (Siddireddy et al, 2015). The researchers measured bacterial bioload on the lids and found a higher amount of bacteria in patients who were symptomatic for contact lens discomfort.

A single microblepharoexfoliation procedure resulted in significant improvements in gland orifice capping, foam at gland orifices, quality of fat secreted from the meibomian glands, and expressibility of the meibum secreted from the glands in the patients who were symptomatic for contact lens comfort issues. What is perhaps most compelling is that of the symptomatic contact lens wearers, 59% of patients who underwent a microblepharoexfoliation procedure became asymptomatic lens wearers.

The Verdict

Identifying signs of blepharitis is critical to optimize our lens wearers’ experience. For our patient, we proceeded with a microblepharoexfoliation procedure and prescribed a regimen of lid hygiene q.d. OD and OS. One month later, his lid margins were remarkably improved in appearance, and his lens comfort had improved significantly. If ignoring the eyelids is the new norm, we don’t want to be normal. CLS

For references, please visit www.clspectrum.com/references and click on document #273.