A patient complained of redness and dryness with corneal GP lenses. We had ruled out tear quality and volume deficiencies as well as meibomian gland dysfunction and giant papillary conjunctivitis. She had grade 1+ conjunctival injection and grade 1+ to 2 staining at 3 o’clock and 9 o’clock. The eyes were refracted at –3.00 –1.50 x 180 OU, with Sim Ks of 43.00 @ 180/44.25 @ 090 OD and 43.50 @ 180/45.00 @ 090 OS. We chose lenses with an overall diameter of 9.6mm, a base curve radius of 7.80mm OD and 7.71mm OS, and an Rx of –3.25D OU, 20/15. Upon slit lamp examination of both eyes, we observed good centration and lag, an aligned fluorescein pattern, proper edge lift, and a grade 2 muco-protein film.
Consider “rule out” factors, including those related to general health (autoimmune diseases, chronic allergies, hormonal changes), medications (diuretics, antihistamines, hormone replacement therapy, birth control pills), and the environment (computer use, ceiling fans, incomplete blink pattern, care regimen).
Next, consider the management categories for treatment.
General Health If chronic allergies are present, attack the allergy pathway and solve this problem, always advising patients that they need to wait, at minimum, 10 to 15 minutes after instilling drops to apply their contact lenses. One option is to prescribe both ketotifen and cromolyn sodium simultaneously; patients usually report quick symptomatic improvement.
Environmental Factors The blink rate decreases to 66% less than normal while staring at a computer, and computer vision syndrome is a highly prevalent condition, affecting 75% of people who work on computers (Gangamma et al, 2010). If this is the problem, recommending that patients take frequent rest breaks from the computer will give them more opportunity to blink. Supplementing with nonpreserved artificial tears should be helpful. Computer placement can also be helpful for lagophthalmos (e.g., a computer higher than eye level can cause incomplete blinking).
Lens Surface A very thin coating of polyethylene glycol can be applied to the lens after manufacturing that makes the lens very wettable and deposit resistant. It can be successful in cases like this one in which traditional methods have not been successful in resolving stubborn deposit issues. An additional benefit is that no daily cleaners or protein removers are required.
Care Regimen Patients must understand that the daily cleaner is exactly that—it needs to be used every day. It is preferable to clean the lens in the palm of the hand upon removal and before soaking overnight in the conditioning solution. Instruct patients not to “re-clean” the lens the next day and thus lose the benefits of the conditioning solution. Switching patients to a hydrogen peroxide system or an extra strength cleaner can be beneficial, as can incorporating an enzymatic protein remover into their regimen. Finally, the use of a nonpreserved artificial tear of moderate viscosity several times throughout the day may help with comfort. CLS
For references, please visit www.clspectrum.com/references and click on document #260.