A minimal percentage of children are likely to suffer dry eye symptoms (4%) compared to 56% of adult contact lens (CL) wearers (Greiner and Walline, 2010). A partial explanation for this is that children report fewer dry eye symptoms compared to adults who have similar signs of ocular surface damage (Han et al, 2013). This highlights the need for careful monitoring of pediatric CL wearers for asymptomatic complications while also underscoring the complexity of the signs-to-symptoms relationship in dry eye management (Stapleton et al, 2017).

Dry Eye and CL Wear

Systemic Medications Teens may be more likely to report CL-related dry eye compared to younger children, although both groups report similar comfort scores (Jones et al, 2009). In both groups, but especially in teens, consider systemic medications (such as acne, anxiety, and depression medications) that could exacerbate dry eye symptoms (Wong et al, 2011). It is yet to be shown whether the digital lifestyle of children and teens today may lead to an increase in dry eye complaints, as may be the case for adults (Nelson et al, 2017).

Allergies The most common pediatric comfort complication is likely to be due to allergy, either in reaction to CL wear or secondary to the growing incidence of childhood allergy; around 10% of children suffer from allergic rhinitis (hay fever), which has a 90% association with ocular allergy (Broide et al, 2011). Both systemic and ocular topical antihistamines are implicated in dry eye disease (Gomes et al, 2017). A history of allergic rhinitis, though, isn’t necessarily a contraindication to CL wear. A small study of 10 adults who had confirmed allergic sensitivity to grass pollen showed a reduction in symptoms of burning and stinging, duration of symptoms, bulbar hyperemia, and corneal and conjunctival staining when daily disposable lenses were worn as a barrier to environmental allergen exposure (Wolffsohn and Emberlin, 2011). There may be a role for daily disposables in providing lubrication and a barrier function in patients who have ocular allergy.

Binocular Vision (BV) BV disorders can cause asthenopia (Rouse et al, 2009), and they have also been linked to dry eye. A study investigating the relationship between CL-induced dry eye symptoms and BV disorders in young adult myopes reported a significant correlation between severity of symptoms with the Ocular Surface Disease Index (OSDI) survey and with the Convergence Insufficiency Symptom Survey (CISS) (Rueff et al, 2015). This correlation was greater compared to any correlations found between OSDI and signs of dry eye. The authors stated that the similar set of symptoms could lead clinicians to confuse a BV disorder for dry eye.

A second investigation by the same authors evaluated young adult myopic contact lens wearers who had self-reported dry eye symptoms. They had a 48% prevalence of a BV disorder; the most common (48%) was an accommodative lag of 1.00D or more. While CL discomfort can be influenced by a variety of factors, the authors recommended that clinicians consistently assess symptomatic CL-wearing dry eye patients for BV disorders to direct best treatment (Rueff et al, 2015).

Assess the Risk

When it comes to balancing the short-term risks of CL wear with the lifelong risks of myopia-associated pathology, a lifetime of CL wear commencing at age 8 carries less risk than does vision impairment in myopia of more than 6.00D or axial length of more than 26mm. When only a childhood of CL wear is considered—from age 8 to 18—the risk comparison is clearly skewed toward the positive impact of CL wear (Gifford, 2020), meaning that clinicians should be confident to proactively recommend myopia management with CLs in younger children, with a mind to managing potential dry eye issues to ensure long-term success. CLS

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