THE TEAR FILM & OCULAR SURFACE Society (TFOS) Dry Eye Workshop (DEWS) III report redefined dry eye disease (DED) as “a multifactorial, symptomatic disease characterized by a loss of homeostasis of the tear film and/or ocular surface, in which tear film instability and hyperosmolarity, ocular surface inflammation and damage, and neurosensory abnormalities are etiological factors” (Perez et al, 2025).

Consistent with the previous TFOS DEWS report, symptoms and signs are used to diagnose DED. Of note, contact lens discomfort symptoms are often the same as DED symptoms. Contact lens discomfort refers to episodes of ocular symptoms that resolve with lens removal (Nichols et al, 2013). However, contact lens wearers may also have existing DED that is exacerbated by lens wear, or they may develop it after starting with contact lenses; contact lens wear is a consistent associated risk factor for DED (Stapleton et al, 2025).

Contact lenses can lead to DED due to their effect on the ocular surface (Jones et al, 2023). They alter the tear film biochemistry and change ocular surface structure and function, summarized in the TFOS DEWS III Digest as follows (Stapleton et al, 2025). Possible mechanisms contributing to DED in contact lens wearers include reduced tear film stability, increased tear evaporation, and mechanical damage to the ocular surface. Increased tear evaporation with a higher frequency of incomplete blinking is found in wearers of both soft and rigid contact lenses. Increased friction between the lens and the ocular surface may be related to meibomian gland dropout and eyelid wiper epitheliopathy. Inferior arcuate corneal staining is more common with soft contact lenses, whereas staining at the 3 and 9 o’clock positions is noted with rigid lenses.

The recommended treatment of contact lens-associated DED generally follows the guidance of the TFOS DEWS III Management and Therapy report (Jones et al, 2025); however, it’s important to note that preserved medications and many products are not specifically registered for use with contact lens wear. Given the potential relationships between DED, meibomian gland dysfunction (MGD), and contact lens discomfort, general strategies include modifying lens material, switching to a daily disposable lens, and using nonpreserved lubricants with contact lens wear. In contact lenses wearers who have MGD, treatment with intense pulsed light (IPL), microblepharoexfoliation, or thermal pulsation are beneficial (Stapleton et al, 2025).

Although contact lenses may negatively impact the ocular surface, they can also protect the surface from eyelid stress forces. The TFOS DEWS III Management and Therapy report outlines treatment algorithms targeting 3 broad etiologic categories of DED: tear film deficiencies, eyelid anomalies, and ocular surface abnormalities (Jones et al, 2025).

Soft and scleral contact lenses act as tear conservation devices that can address tear film deficiencies. For blink and lid closure anomalies, soft bandage lenses and especially scleral contact lenses are used to manage chronic exposure. Finally, amniotic membranes may be placed under contact lenses to treat ocular surface abnormalities.

The relationship between contact lenses and DED is complex. Although contact lens wear may lead to DED, contact lenses may also be used as a treatment strategy Understanding the distinctions between etiologic subtypes of DED can aid in targeted management.

References

1. Perez VL, Chen W, Craig JP, et al. TFOS DEWS III: Executive Summary. Am J Ophthalmol. 2026;282:135-145. doi: 10.1016/j.ajo.2025.09.035

2. Nichols KK, Redfern RL, Jacob JT, et al; members of the TFOS International Workshop on Contact Lens Discomfort. The TFOS International Workshop on Contact Lens Discomfort: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci. 2013;54(11):TFOS14-TFOS19. doi: 10.1167/iovs.13-13074

3. Stapleton F, Argüeso P, Asbell P, et al. TFOS DEWS III: Digest. Am J Ophthalmol. 2025 Nov;279:451-553. doi: 10.1016/j.ajo.2025.05.040

4. Jones L, Efron N, Bandamwar K, et al. TFOS Lifestyle: Impact of contact lenses on the ocular surface. Ocul Surf. 2023;29:175-219. doi: 10.1016/j.jtos.2023.04.010

5. Jones L, Craig JP, Markoulli M, et al; TFOS Collaborator Group. TFOS DEWS III: Management and Therapy. Am J Ophthalmol. 2025;279:289-386. doi: 10.1016/j.ajo.2025.05.039