Your patient has eye dryness and contact lens-related discomfort. What’s the cause? It is hard to say until you get more information. Are his or her symptoms due to true underlying dry eye that needs to be aggressively addressed, or are they due to contact lens-related dryness that lends itself to being refit into a different material or modality? Focus on finding the primary underlying cause.

Distinguish Between Contact Lens Dryness and True Dry Eye

This starts with a short mental checklist (Townsend, 2008).

Contact Lens-Related Dryness:

• Dryness mostly when wearing contact lenses and usually after six to eight hours of wear
• Intermittent blurriness/vision decreases throughout the day
• Visible lens surface dryness
• Younger demographics affected

True Dry Eye:

• Symptoms with and without contact lens wear
• Use of medications known to contribute to dry eyes or having an associated systemic disease (rheumatoid arthritis, rosacea, etc.)
• Previous ocular surgery (photorefractive keratectomy, laser-assisted in-situ keratomileusis, etc.)

Environmental and occupational conditions will also contribute to both contact lens-related dryness and true dry eye. That is good information to know, but it is not really helpful in your differential.

Use the Right Treatment Plan

Developing a treatment plan begins with a good history and determining the chief complaint. Do patients use any eye drops throughout the day? What are their symptoms and compliance with contact lens wear? I tell patients, “I want to provide the most optimal contact lens for your eyes, and I need to know some details of your wearing experience with your current lenses.” For example, ask when and why they remove their lenses along with how many hours of comfortable lens wear they have on an average basis.

Choose treatment plans based on patients’ individual issues and what will improve their specific condition:

• True Dry Eye Depending on the severity of their dry eye, patients may need to be removed from contact lens wear during treatment of their underlying condition. This type of patient will need more than basic artificial tears; rather, these patients will most likely need some form of pharmaceutical and/or procedure to improve their condition. If their dry eyes are related to some form of meibomian gland dysfunction, attack that first.
  However you decide to treat patients who have true dry eye, utilize scientific evidence and protocols to improve their condition and to help them return to comfortable contact lens wear as soon as possible.
• Contact Lens-Related Dry Eye When patients experience symptoms only during contact lens wear and not at any other time, refit them into a new material or modality. Make this a fun process for patients. I tell them, “it is sometimes difficult to assess your comfort level until you have an opportunity to experience a different contact lens.”
• A Combination of Both I have found that it is often difficult to separate these conditions. Many patients need treatment for an underlying dry eye condition and to be refit into a different material or modality. Encourage patients to have patience as you work through this process.

True dry eye and contact lens-related dry eye are often linked. Utilize a systematic approach to get to the heart of the issue, and focus on returning patients to comfortable lens wear as soon as possible. CLS

For references, please visit www.clspectrum.com/references and click on document #296.