discovering
dry eye
A
Look Back at the Year in Lens-related Dry Eye
BY
KELLY K. NICHOLS, OD, MPH, PHD
I'm reminded at this time of year to reflect
on the good things and to plan for the future. In looking back over the last 12
months, a best-of list of pearls in lens-related dry eye comes to mind.
Meibomian
gland disease is common in contact lens wearers and can lead to lens discomfort.
Treat aggressively with warm compresses, lid hygiene and/or doxycycline.
Patient management in contact lens-related dry eye takes
time, but the rewards are worth it. Book the extra time-slot, perform a
dry eye work-up (bill medically for it) and your patients will appreciate the extra
attention to the problem.
Add lissamine green to your contact lens dry eye diagnosis
protocol. Significant conjunctival staining in a ring pattern and superior
lid margin staining (lid wiper epitheliopathy) may be correlated with symptomatic
contact lens wear.
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Figure 1. Interferometric analysis of tear
film thinning over a silicone hydrogel lens surface
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Dry eye has an inflammatory component. Whether the
etiology of the condition is inflammatory or inflammation is a result of the disease
process, bulbar conjunctival and/or lid margin injection can be subtle signs that
you can monitor with treatment.
Changes in a patient's quality lens wear (and quality of
life) can be very meaningful. Ask about and monitor the number of times
a patient uses lubricant eye drops and the difference between total lens wear time
and comfortable lens wear time. Improvements in either by a minimal amount may have
a significant impact on satisfaction with contact lens wear.
Best
photo: Can a picture speak 1,000 words? (Figure 1).
We have a lot to learn about the interaction among the lens
surface, tear film thinning, evaporation and symptoms. The future will hold
specific solution/ lens pairings to maximize tear film stabilization and comfort.
A step-wise approach catered to each patient is the most
successful in managing contact lens-related dry eye. Consider contact lens
characteristics, wearing schedule, lens solutions, lubrication, lid disease management,
cyclosporine, nutraceuticals, punctal occlusion and reduced contact lens wear time.
Symptomatic contact lens wearers have "sticky" tears. Have
your new dry eye patients commit to a two-week trial of lubricant eye drops three
to four times a day (pre-lens wear, during and post lens wear). It takes two weeks
to make a new habit (and the New Year is a great time to start one!).
You can successfully use cyclosporine (Restasis, Allergan)
with contact lens patients. Discuss medical management with your patients,
including the financial cost/benefit ratio of reducing artificial tear use.
Don't change everything at once. Write down what
you recommend, then follow up.
Watch for guidelines. Recommendations on treatment
from the international task force Delphi panel and the status of the dry eye field
(research, etiology, diagnosis and management and clinical trials) from the international
Dry Eye Workshop (DEWS) will be published in 2007.
The New Year promises to bring more advances in disease management,
new products and treatments. Stay tuned!
Dr. Nichols is an associate
professor at The Ohio State University College of Optometry in the area of dry eye
research.
Contact Lens Spectrum, Issue: December 2006