Corneal and scleral GP lens-induced dryness can be frustrating and challenging. Here are some clinical pearls for when you have a GP wearer in your chair who has symptoms and/or clinical signs of dryness that would not have been predicted when this patient was originally fit into GP lenses several months previously.

1. Corneal GP Lenses Dryness can often occur as a result of inferior lens decentration, which results in excessive edge clearance superiorly and more lid-lens edge interaction; therefore, incomplete blinking can result, followed by drying out of the tear film as well as both subjective symptoms of dryness and redness accompanied by corneal desiccation and surface filming. This problem can be minimized by ordering the lens in an ultrathin design. Also, the use of a lenticular, i.e., a plus lenticular in all high-minus-power lenses (often ≥ 5.00D) and a minus lenticular for all plus-power and low-minus-power lenses (≤ –1.50D), can promote good centration (Bennett et al, 2014). The use of a bitoric GP lens in all patients who have greater than 2.00D of corneal cylinder will also promote good centration and comfort.
2. Scleral GP Lenses With scleral lenses, an appropriate landing zone relationship with the conjunctiva and underlying scleral profile is critical. Either impingement or excessive edge lift can cause dryness. The best solution is to take photos or video—with a slit lamp camera or a cell phone—to send to the laboratory consultant who can then recommend design modifications to solve the problem.
3. Both Corneal and Scleral Lenses Surface treatments, notably a 90% water polyethylene glycol (PEG)-based polymer, can be beneficial to help minimize dryness problems. Pharmaceutical treatment, including agents such as lifitegrast and cyclosporine, can work well for patients. Additionally, oral nutritional supplementation for the eye works remarkably well to help patients who have lens discomfort.
4. Electronic Device-Induced Dryness A new area of concern with GP wearers is electronic device desiccation (EDD). The increasing use of cell phones and computers—notably by young people—can result in dryness-related problems.
   Prolonged gaze suppresses the normal blinking pattern by inhibiting the natural replenishment of the tear film that is created by each blink. As patients stare at a device, the natural replenishing of the tear film is delayed, which can also potentially induce peripheral corneal desiccation and drying of the tear film on the lens surface.
   The “20/20/20 Rule”—a computer user should take a break every 20 minutes to look at an object at least 20 feet away for, at minimum, 20 seconds (Safety Memos, 2014)—can be beneficial in these cases. The same applies to young people using their cell phones for several hours every day. Smartphone use in children has been strongly associated with pediatric dry eye disease (DED); however, outdoor activity appeared to be protective against pediatric DED (Moon et al, 2016).

Find the Best Strategy

Obviously, there are many additional strategies that can help you make your contact lens fittings successful for patients who exhibit dry eye symptoms. However, for GP-induced dryness in 2018, these guidelines should be beneficial in reducing this problem. CLS

For references, please visit www.clspectrum.com/references and click on document #272.