GP lens depositing can be a frustrating problem for both patients and eyecare providers. Attempts to address depositing usually include changes to patients’ cleaning regimen, lens material, surface treatments, coatings, or even lens fitting properties. While these changes can be helpful, sometimes they aren’t enough to fully eliminate stubborn depositing.

While hydrogel lens deposits tend to be more protein-based, GP lenses attract more lipids, with silicone-based lenses even more so compared to GPs containing fluorine. Of particular interest is the fact that GP lens deposits, when isolated, tend to be the lipids that are naturally attracted to the more hydrophobic GP materials. These include triglycerides, cholesteryl esters, and wax esters (Green-Church et al, 2011).

Advances in liquid chromatography and mass spectrometry have made analysis of intact lipid samples from meibomian glands much more accurate and have shown human meibum to consist largely of non-polar wax and cholesteryl esters, with a smaller portion of more polar lipids (Butovich, 2017).

It also should be noted, however, that lipids isolated directly from meibum may not exactly match those found in the tear film and may themselves be altered due to contact lens wear (Nichols et al, 2011). Regardless, enough of a match exists to suggest a correlation between meibum and GP lens depositing. It also suggests that when fitting GP lenses, practitioners should pay closer attention to meibomian glands than they normally would when troubleshooting deposits.

MGD and Deposits

It is logical to think that the hypersecretory forms of meibomian gland dysfunction (MGD) may be more likely to lead to contact lens deposits than the obstructive or hyposecretive forms would (or when there is diffuse meibomian gland dropout, as in Figure 1), though this remains unconfirmed. Any type of meibomian gland disease could cause abnormal lipid quality and/or quantity, and practitioners should address this area if GP contact lens depositing is a persistent issue.

In fact, if a hyposecretory form of MGD causes significant tear film instability, deposits may result from an imbalance of tear film components. Additionally, bacterial lipase enzyme activity is likely detrimental to ocular lipid stability and may need to be addressed concurrently (Nattis et al, 2019).

Treatment Options

Treatment options for MGD—and therefore for GP deposits—vary based on disease severity but may include warm compresses, digital massage and compression of meibomian glands, omega-3 dietary supplements, and topical or oral antibiotics. When used regularly, lid hygiene products can be useful, particularly those that have antibacterial properties. Hypochlorous acid solutions, now readily available over the counter and by prescription, cleanse eyelids and have been shown to significantly reduce harmful periorbital bacteria without affecting beneficial ocular flora (Stroman et al, 2017). A starting regimen of once- or twice-daily warm compresses with daily use of a lid hygiene product can help treat and prevent GP deposits in even the most stubborn cases if patients are compliant.

The Right Perspective

Rather than looking at the GP lens to problem-solve depositing issues, it can be necessary to look at patients and their eyelids instead. With diligent efforts to improve and maintain meibomian gland function, patients will often find that “clean lids make for clean lenses.” CLS

For references, please visit www.clspectrum.com/references and click on document #301.