Despite the magnificent advances in contact lens materials, contact lens wear remains a risk factor for dry eye, especially in those who have underlying ocular surface issues (Kojima, 2018). One study found that nearly 53% of contact lens wearers suffer from dry eye, which is a much higher percentage than is found in the general population (Scaffidi and Korb, 2007). This presents a problem in clinical practice. At times, we may find ourselves performing somewhat of a balancing act managing both contact lens comfort and dry eye syndrome.

Fortunately, there has been quite a bit of research on this association that proves helpful when addressing it with patients. One such document is the Tear Film & Ocular Surface Society’s (TFOS) International Workshop on Contact Lens Discomfort (CLD) (Papas et al, 2013). Very specific CLD management strategies were outlined in the TFOS report.

In the report, practitioners are encouraged to do things like alter lens care systems, adjust replacement schedules, change lens designs or materials, incorporate tear supplementation, consider dietary supplementation, and improve the patient’s environment. While most of these recommendations may appear intuitive, the report does an excellent job of outlining these management options using a clear, evidence-based approach.

On the Topic of Tears

Reflecting on this report, I have personally changed my prescribing habits with regards to rewetting drops. Whereas I previously may have been more inclined to adjust a lens material, I am now much more aggressive with recommending topical rewetting drops for contact lens wearers.

The advantage of topical drops on top of a contact lens is consistent with the idea that contact lens dryness can be related to surface wettability (Tonge et al, 2001). The literature indicates that they can have a positive impact on the ocular surface when used with contact lenses (Pucker, 2020; Subbaraman et al, 2006).

It is important to periodically review the various aspects of tear film. Our tears are composed of electrolytes, water, proteins, mucins, and lipids. These components come together to create two distinct layers: the lipid layer (outmost) and the aqueous-mucin phase against the hydrophobic corneal epithelium (Craig et al, 2017). Understanding the integrity of these layers allows for a much more targeted approach for patients.

For example, if a patient has meibomian gland dysfunction, the lipid layer of the tear film will be compromised. There are drops designed to help supplement the lipids of the tear film (Aguilar et al, 2014; Ousler et al, 2015). Other drops have been designed to mimic the mucin layer of the natural tear film assisting tears to adhere to the ocular surface (Montani, 2013; Davitt et al, 2010).

Avoid Patient Dropout

If practitioners do not address the contact lens dryness issue, they run the risk of increasing dropout rates and having their patients discontinuing contact lenses indefinitely (Young et al, 2002). A fascinating thing was found in a retrospective chart review study: 71% of patients who dropped out of their contact lenses were provided no alternative lens or management strategy (Sulley et al, 2017).

This is avoidable. Tools are available to keep patients in their contact lenses. Let’s do the best to ensure dry eye isn’t a factor. CLS

References

1. Kojima T. Contact Lens-Associated Dry Eye Disease: Recent Advances Worldwide and in Japan. Invest Ophthalmol Vis Sci. 2018 Nov 1;59:DES102-DES108.
2. Scaffidi RC, Korb DR. Comparison of the efficacy of two lipid emulsion eye drops in increasing tear film lipid layer thickness. Eye Contact Lens. 2007 Jan;33:38-44.
3. Papas EB, Ciolino JB, Jacobs D, et al; members of the TFOS International Workshop on Contact Lens Discomfort. The TFOS International Workshop on Contact Lens Discomfort: report of the management and therapy subcommittee. Invest Ophthalmol Vis Sci. 2013 Oct 18;54:TFOS183-TFOS203.
4. Tonge S, Jones L, Goodall S, Tighe B. The ex vivo wettability of soft contact lenses. Curr Eye Res. 2001 Jul;23:51-59.
5. Pucker AD. A Review of the Compatibility of Topical Artificial Tears and Rewetting Drops with Contact Lenses. Cont Lens Anterior Eye. 2020 Oct;43:426-432.
6. Subbaraman LN, Bayer S, Glasier MA, Lorentz H, Senchyna M, Jones L. Rewetting drops containing surface active agents improve the clinical performance of silicone hydrogel contact lenses. Optom Vis Sci. 2006 Mar;83:143-151.
7. Craig JP, Nelson JD, Azar Dt, Belmonte C, Bron AJ, Chauhan SK, de Paiva CS, Gomes JAP, Hammit KM, Jones L, Nichols JJ, Nichols KK, Novack GD, Stapleton FJ, Willcox MDP, Wolffsohn JS, Sullivan DA. TFOS DEWS II Report Executive Summary. The Ocular Surface. 2017 Aug;1-11.
8. Aguilar AJ, Marquez MI, Albera PA, Tredicce JL, Berra A. Effects of Systane(®) Balance on noninvasive tear film break-up time in patients with lipid-deficient dry eye. Clin Ophthalmol. 2014 Nov 25;8:2365-2372.
9. Ousler G 3rd, Devries DK, Karpecki PM, Ciolino JB. An evaluation of Retaine™ ophthalmic emulsion in the management of tear film stability and ocular surface staining in patients diagnosed with dry eye. Clin Ophthalmol. 2015 Feb 5;9:235-243.
10. Montani G. Intrasubject tear osmolarity changes with two different types of eyedrops. Optom Vis Sci. 2013 Apr;90:372-377.
11. Davitt WF, Bloomenstein M, Christensen M, Martin AE. Efficacy in patients with dry eye after treatment with a new lubricant eye drop formulation. J Ocul Pharmacol Ther. 2010 Aug;26:347-353.
12. Young G, Veys J, Pritchard N, Coleman S. A multi-centre study of lapsed contact lens wearers. Ophthalmic Physiol Opt. 2002 Nov:22;516-527.
13. Sulley A, Young G, Hunt C. Factors in the success of new contact lens wearers. Cont Lens Anterior Eye. 2017 Feb;40:15-24.