contact lens practice pearls
Keeping Symptomatic Patients in Contact Lenses
By Thomas G. Quinn, OD, MS, FAAO
Ask patients who complain of dryness with contact lens wear how their eyes feel when lenses are not worn. If they indicate their eyes feel fine, it's possible they have borderline dry eye that gets pushed “over the edge” with lens wear, or they may be experiencing low grade irritation. Irritation may be caused by poor lens fit, hypoxia, solution-lens-patient incompatibility or from soiled lenses. Of these possible etiologies, I believe soiled lenses are often the culprit.
Ask symptomatic patients to review how they care for their lenses. Key questions include:
What kind of hand soap are you using?
Some hand soaps contain lotions and perfumes that can be transferred from the hands to the lenses, leading to discomfort.
What contact lens care system do you use?
For comfortable contact lens wear to be achieved, all three players: the patient, the lens and the care system, must be compatible with one another. Consider changing lens materials or lens care products if all other findings check out.
What do you do with your lenses once they are out?
If the patient isn't rubbing the lenses on removal, simply adding this step can significantly improve comfort in my experience.
How do you care for your lens case and how often do you replace it?
Numerous reports at the 2010 meeting of the American Academy of Optometry suggest case contamination is a source of many contact lens-related complications (Wu, 2010; Woods, 2010). The FDA recommends cleaning, rinsing and air-drying the case each time lenses are removed. Flip the case over so excess solution can drain out. Replace the case at least every 3 months (fda.gov).
How often are you replacing your lenses?
I get the most honest response if I ask this question while I'm performing the slit lamp exam. Patients who say “when they start to bother me” need to be educated that the goal is to replace the lenses before discomfort begins.
Live by the Lid
Many causes for contact lens discomfort can be revealed simply by looking at the eyelid. Eyelid inflammation is reported to be present in 67-75 percent of patients who complain of dryness (Laurenzi, 2008). Look for red, beefy eyelid margins, suggestive of meibomian gland dysfunction. This is often most easily observed during external observation with the naked eye. Use the slit lamp to view the lid margins and gland openings. Look for frothing along the lid margin. Express the glands and look for particulate matter or a waxy expression.
A variety of treatments can be employed, including lid scrubs, hot compresses, and topical and oral medications.
All contact lens wearers should routinely have their upper eyelids everted to look for giant papillary conjunctivitis. If present, treatment is straightforward: improve the cleanliness of the lens. This can be accomplished by improving care techniques, replacing the lens more frequently or switching to a different care system.
Listen, Then Look
A thoughtful case history, followed by a thorough anterior segment exam, usually will uncover the cause of contact lens-related discomfort. Once identified, employ appropriate treatment strategies to keep your patients happily wearing their lenses. CLS
For references, please visit www.clspectrum.com/references.asp and click on document SE2011.
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.