Follow these tips to prevent dry eye disease-related contact-lens dropout

About 12% to 51% of new contact lens wearers dropout within three years due to discomfort.¹ In understanding dry eye disease (DED) and how to treat it, it’s clear many optometrists are missing the opportunity to treat their patients’ DED and enable them to continue wear.

1 ASSESS THE NAKED EYE

If nothing is wrong with the contact lens fit and prescription, look at the lids and ocular surface to find the underlying cause of the patient’s discomfort. At a minimum, we should stain these patients’ corneas and conjunctivas, evaluate TBUT, measure the tear lake, flip their lids and express their glands. These items coupled with an in-office patient survey, such as SPEED or OSDI, can help direct treatment. (I have found that patients who have inferior 1/3rd corneal staining may be voracious readers or have lagophthalmos, floppy eyelid syndrome, sleep using a fan or even have an ill-fitting CPAP mask. All will worsen DED and should be addressed.) Additionally, point-of-care diagnostic testing, which can be found at bit.ly/33yF0Ij , can further confirm the diagnosis.

2 TAILOR DISEASE MANAGEMENT

We should prescribe treatment(s) based on findings. For example, if the patient’s primary issue is aqueous deficiency, we should prescribe inflammatory inhibitors that improve tear quality and quantity. Topical steroids aid in decreasing the initial discomfort and inflammation when starting these medications. Both treatments should be instilled 15 minutes prior to contact lens-insertion or after removal.

Blepharitis and meibomian gland dysfunction (MGD) can exacerbate the tear film instability, already caused by wear, thereby increasing contact lens discomfort. Conservatively, we should start these patients on a lid hygiene regimen that includes lid scrubs with a dedicated lid cleanser, a heated eye mask with eyelid massage and omega-3 and omega-6 nutritional supplements. We may also want to consider in-office lid margin debridement to remove the biofilm and keratinization that can develop over the duct orifices.²

More aggressive treatments are often needed in moderate to severe disease, including oral antibiotics, amniotic membranes or amniotic membrane drops, autologous serum, in-office lid treatments, punctal plugs and intense pulsed light. (For an extensive look at all treatment options, visit bit.ly/33AuHnb .)

3 PRESCRIBE A DIFFERENT SOLUTION

Some patients may complain of ocular dryness, due to sensitivity to the preservatives in multipurpose solutions. Prescribing a hydrogen peroxide-based cleaning solution often helps in these cases. This also is helpful to utilize in patients who are known to have contact lens deposits and seasonal allergies.

THE OTHER CULPRIT

In cases of ocular allergy or contact lens material sensitivity, we should take these patients out of contact lens wear until the inflammation and the papillae have completely resolved. This may also require refitting patients in a different modality or lens material. OM

REFERENCES

1. Dumbleton K, Caffery B, Dogru M, et al. The TFOS International Workshop on Contact Lens Discomfort: report of the subcommittee on epidemiology. Invest Ophthalmol Vis Sci. 2013 Oct 18;54(11):TFOS20-36.
2. Jones L, Downie, LE, Korb D, et al. TFOS DEWS II management and therapy report. Ocul Surf. 2017 Jul;15(3):575-628.

DR. KOETTING practices at Virginia Eye Consultants, and she is adjunct faculty for Pacific University, MCPHS, Salus University, Southern College of Optometry and the University of the Incarnate Word. She has received consulting fees or honorariums from Oyster Point, Glaukos, Quidel, Horizon, Ocular Therapeutix and Eyevance.