contact lens practice pearls
Tried and True Tricks for Managing Contact Lens Dryness
BY THOMAS G. QUINN, OD, MS, FAAO
Another of your soft contact lens patients has presented complaining of dryness symptoms. How should you proceed when the usual approaches don't work?
Confirm the Cause The complaint of "dryness" can arise from multiple sources. Begin by ruling out conditions that may be masquerading as dry eye. These include low-grade mechanical irritation from a poorly fitting or coated lens, hypoxia associated with wear of a low-Dk/t lens, or chemical incompatibility of a care system with either the eye or the lens material.
Material Matters If symptoms are due to a truly dry eye, avoid high-water-content hydrogel materials. Some evidence suggests that silicone hydrogel materials may reduce dryness symptoms. Lenses such as Pro-clear (CooperVision) or Extreme H2O (Hydrogel Vision Corp.) may be helpful.
Some dry eye patients will complain of discomfort — more specifically burning — after wearing any soft lens for more than a few hours. I've had good success refitting these patients with GP lenses. GP lenses don't draw fluid from the tear reservoir like soft lenses do, thus reducing dryness symptoms. It is very important to educate these soft lens wearers about the eyelid adaptation required with the transition to GP lenses. I find it helpful to equate this adaptation to the adjustment a wrist undergoes with wear of a new watch or a finger with wear of a ring. After a week or two, awareness of the lens with the blink will subside, as will the symptom of burning they experienced with soft lens wear.
Switch Patients to Daily Disposables Lenses on dry eyes coat more rapidly than those on moist eyes. Daily disposable lenses can provide a huge improvement in comfort for these patients. Such patients also often remark that their vision is no longer "foggy" because the lens surface is clean.
Lubricate Before Application There is some evidence to support the notion that instilling a lubricating eye drop in the eye prior to lens application cannot only improve initial comfort, but may also increase end-of-day comfort. Part of the appeal of this approach is that it's easy and inexpensive to try.
When All Else Fails
When I've tried various drops, lenses, supplements, and care systems and patients still complain of dryness, I tell them to try the following tricks.
Add Moisture to the Room A humidifier is a practical option, particularly when patients tend to be fairly stationary such as someone who works at the same desk all day.
Take a Mid-Day Break Have patients remove their lenses over lunch to give their eyes a mid-day rest. At the same time, the lenses can be "regenerating" as they soak in solution while not being worn. I've found this approach to be much more effective than frequent instillation of rewetting drops.
Wear Sunglasses In addition to blocking harmful ultraviolet light rays, sunglasses protect the eyes from wind and dust, two factors that can aggravate dryness.
Well Worth it
Patients who have severely dry eyes may require more advanced treatment strategies such as scleral lenses, but I've found that most dry eye patients can benefit from the strategies above, even if they remain limited to part-time wear. For those who have enjoyed the freedom and other benefits of contact lens wear, even part-time relief from the confines of glasses is a wonderful gift. CLS
Dr. Quinn is in group practice in Athens, Ohio. He is a diplomate of the Cornea and Contact Lens Section of the American Academy of Optometry, an advisor to the GP Lens Institute and an area manager for Vision Source. He has served as an advisor or consultant to Coopervision, CIBA Vision and Vistakon and has received research funding from AMO, B&L, CIBA Vision, Coopervision, and Vistakon.