THERE ARE SO many ocular surface components that can relate to the success or failure of wearing contact lenses. Corneal shape, scleral shape, conjunctival health, and the quality of the tear film are just a few of these factors. An oftentimes overlooked factor is the eyelids and their role in contact lens success.

THE LIDS’ ROLE

Loose Lid Apposition Lid apposition is critical to assess. Practitioners should evert every patient’s eyelids to assess the health of the palpebral conjunctival surface, the presence of lid wiper epitheliopathy, and the elasticity of the lid margin. Patients who have loose lid apposition may experience some discomfort in the morning, making lenses less comfortable.

In more extreme situations, it could be associated with floppy eyelid syndrome. In addition to spontaneous lid eversion in the evening, this condition has a strong association with sleep apnea (Teodor and Mihaltan, 2019). These individuals will often be using continuous positive airway pressure masks. It is critical to identify these patients to provide them with appropriate options for treatment to prevent lens discomfort. Options include eye masks, lid seals, tear ointments, and, potentially, eyelid surgery.

Ptosis Ptosis can affect the superior visual field and reduce the level of light entering the eye. This can be a significant factor when considering the patient wearing simultaneous designed multifocal contact lenses. These lenses split light signals between distance and near optics, so anything that affects light entering the eye can detract from the intent of the lens design. Treatment options involve 0.1% oxymetazoline eye drops to treat blepharoptosis or eyelid surgery.

Blepharitis With blepharitis, excessive microorganisms that can be visible on the lash margin and the inflammation can negatively affect lens comfort (Siddireddy et al, 2020). It is critical to examine the lash margin closely (using a high magnification is recommended) while having the patient look down. Treatment includes lid hygiene, antibiotic eye drops, and in-office procedures such as microblepharoexfoliation. Recently a drop for Demodex blepharitis was submitted to the U.S. Food and Drug Administration for approval, and will likely add to our clinical armamentarium.

Meibomian Gland Dysfunction (MGD) The meibomian glands are key in producing the lipid layer of the tear film. Meibomian gland warming and evacuation procedures performed in the office provide a means to rehabilitate the glands. Oral doxycycline and azithromycin have also been shown to improve MGD signs and symptoms (Benedetti and Vaiano, 2019). Intense pulsed light is also being used to improve meibomian gland function (Tashbayev et al, 2020). Additionally, several medications are currently being studied that may provide practitioners with a topical treatment that is approved to treat MGD.

Lid Seal This is the seal created by the lid margins of the upper and lower lids coming together to protect the eyes when they are closed. The Korb-Blackie light test assesses the presence of inadequate lid seal if light escapes from the lid margin when the eyes are closed and a transilluminator is placed at the superior portion of the tarsal plate (Blackie and Korb, 2015). Poor lid seal can create symptoms of dryness that can affect contact lens comfort (Blackie and Korb, 2015). Eye masks, lid taping, or ointments can help with exposure and eye comfort with contact lenses.

THE VERDICT

The eyelids play an important role in contact lens success. If ignoring the lids is the new norm, we don’t want to be normal. CLS

REFERENCES

1. Teodor RC, Florin Dumitru Mihaltan. Eyelid laxity and sleep apnea syndrome: a review. Rom J Ophthalmol. 2019 Jan-Mar;63:2-9.
2. Siddireddy JS, Vijay AK, Tan J, Willcox M. Effect of Eyelid Treatments on Bacterial Load and Lipase Activity in Relation to Contact Lens Discomfort. Eye Contact Lens. 2020 Jul;46:245-253.
3. De Benedetti G, Vaiano AS. Oral azithromycin and oral doxycycline for the treatment of Meibomian gland dysfunction: A 9-month comparative case series. Indian J Ophthalmol. 2019 Apr;67:464-471.
4. Tashbayev B, Yazdani M, Arita R, Fineide F, Utheim TP. Intense pulsed light treatment in meibomian gland dysfunction: A concise review. Ocul Surf. 2020 Oct;18:583-594.
5. Blackie CA, Korb DR. A novel lid seal evaluation: the Korb-Blackie light test. Eye Contact Lens. 2015 Mar;41:98-100.