Even though we, as eyecare practitioners, have many options for our keratoconus patients, the plan that we take is often dictated by the severity of the keratoconus. Those who have mild forms of keratoconus do well with soft lenses or even spectacles, whereas advanced cases require a more customized approach. But how often is dry eye a consideration when it comes to your keratoconus patients?

One study indicated that patients who have keratoconus also have lower tear volumes and tend to be very symptomatic for dry eye (Carracedo et al, 2015). It is important that we understand this, because the overall wearing experience can play a large role in reducing potential patient dropout.

When it comes to specialty contact lenses and dry eye, scleral lenses do seem to be the design of choice, because they have a low interaction with as well as provide constant lubrication to the cornea. But despite these advantages, some patients who wear scleral lenses still have symptoms of dryness. In those instances, here are a few tips that we can employ.

Lens Treatments

Lens treatments, such as a polyethylene glycol (PEG)-based coating, are a great option in this regard. This mixture, which is bonded to the surface of the contact lens, is extremely effective in maintaining a wetting surface for the lens material. While we can see clinically how it improves lens surface wettability, one study indicated that it also improves tear breakup time, increases lubricity, and reduces protein and lipid deposition (Sindt, 2016).

Artificial Tears

Off-label use of non-preserved artificial tears with scleral lenses may be a way to assist patients who are suffering from dryness. Although the cornea is bathing in the tear reservoir, the conjunctival surface is not covered by these large-diameter lenses. Additionally, not adequately lubricating this area can produce symptoms of dryness.

Another benefit of artificial tears is related to the lens surface. Lubrication drops can play a large role in reducing the friction of the lid rubbing against the lens.

Filling Solutions

Using an appropriate scleral contact lens filling solution can go a long way to address your patients’ dry eye issues. Unfortunately, patients do not always follow our initial instructions. Therefore, it is always a good idea to confirm what your patients are using. Acceptable choices include a few commercially available, non-preserved, non-buffered solutions as well as off-label sodium chloride 0.9% inhalation vials.

Wearing Time

Another area to address with your patients would be the amount of time that they are wearing their lenses. Depending on the severity of their keratoconus, it may not be appropriate for patients to wear their lenses for the entire day. Setting an appropriate lens-wearing plan in such cases may be useful.

Anecdotally, we may think that patients who wear scleral contact lenses would have less dry eye symptoms compared to with wear of other lens modalities. However, the truth is that these patients can still suffer from symptoms associated with dry eye.

When managed correctly, we can effectively balance the advantages of scleral lenses while, at the same time, addressing our patients’ dry eyes. CLS

For references, please visit www.clspectrum.com/references and click on document #312.