Contact Lens Design & Materials
Dry Eye: Look Beyond the Contact Lens
BY RONALD K. WATANABE, OD, FAAO
When a contact lens wearer presents with complaints of dryness, the knee-jerk reaction is to start thinking about new lens options in which to refit the patient. Novel contact lenses are being introduced frequently, so it makes sense to want to try the latest and greatest when a patient is not happy. New material technologies aim to maintain better lens hydration so that the lens surface does not feel as dry as that of more traditional materials. These may be more comfortable for many patients who have dry eyes, but there are other factors that are just as important when trying to solve a patient’s dry eye problems.
Ruling out underlying dry eye disease is an important first step. Blepharitis and meibomian gland dysfunction are common conditions that contribute to dryness. Tear volume, tear breakup time, and osmolarity, as well as corneal and conjunctival staining with fluorescein and lissamine green dyes, are critical in defining the type and degree of disease.
Dry eye treatment can take on many forms and should be based on patients’ symptoms and signs. Artificial tears, lid hygiene, and/or punctal plugs may help decrease dryness symptoms without having to change lens materials. Cyclosporine drops may help improve tear production in the aqueous-deficient. Omega-3 supplements may help improve tear film stability. In extreme cases, autologous serum may be of benefit.
Many oral medications can cause dry eye, including allergy medications (H1 antagonists, decongestants), gastrointestinal medications (H2 antagonists, proton pump inhibitors), blood pressure medications (beta blockers, diuretics), hormone replacement therapy, antidepressants, and antipsychotics. Though we may not change these medications, educating patients that their medications can cause dryness may help them better understand and deal with their dry eye issues.
Some systemic diseases are associated with dry eye, including diabetes, thyroid disease, autoimmune diseases such as Sjögren’s syndrome and rheumatoid arthritis, and rosacea. Treatment of the systemic disease along with ocular management of dry eye is the best approach to reduce patient symptoms.
Patients who live and/or work in low humidity environments may suffer increased evaporation of the ocular and contact lens surfaces, resulting in dryness. Modifying the environment with a humidifier can reduce symptoms.
Making your patients more aware of their blink habits or having them take more breaks from visually demanding tasks, such as computer work, may also help to reduce their dry eye symptoms.
Lens Care Products
Lens care solution components can cause sensitivity reactions that may create dryness symptoms. Multipurpose solutions, in particular, contain ingredients to clean, disinfect, and condition contact lenses. These ingredients (preservatives, surfactants, etc.) can potentially cause sensitivity or allergic responses in the eye, such as ocular redness, surface staining, or papillary response. Changing to an unpreserved disinfecting system or to a daily disposable lens modality may reduce these problems.
Reducing contact lens dryness can be a complicated process, but considering factors in addition to contact lens materials can maximize your ability to alleviate your patients’ dry eye complaints. CLS
Dr. Watanabe is an associate professor of optometry at the New England College of Optometry. He is a Diplomate in the American Academy of Optometry’s Section on Cornea and Contact Lenses and Refractive Technologies and is in private practice in Andover, Mass. You can reach him at email@example.com.