Many of the patients I see present to the practice due to an inability to continue to wear their contact lenses for as many hours as they would like. Typically, these patients have dry eye disease (DED), which decreases their contact lens tolerability.

Maintaining a robust tear film in these patients is critical. These patients want to wear their contact lenses for as long as it is safe to do so and remain in contact lens wear for years to come. Additionally, developing a healthy tear film allows them to consider refractive surgery options in the future.

Let’s discuss interventions to improve the tear film in these patients.

Increase tear volume
Tear secretion is controlled by the lacrimal functional unit, which consists of the goblet cells on the ocular surface, lacrimal glands, meibomian glands, and the interconnecting innervation. If any portion of this functional unit is compromised, lacrimal gland support to the ocular surface is impeded.¹ Stimulation of the lacrimal functional unit increases aqueous, mucin, and oils in the tear film. Several medications are available to increase the tear volume. They are varenicline solution nasal spray 0.03 mg (Tryvaya, Viatris),² cyclosporine ophthalmic solution 0.05% (Restasis, AbbVie), cyclosporine ophthalmic solution 0.09% (Cequa, Sun Pharma), cyclosporine ophthalmic solution 0.1% (Vevye, Harrow)³, and liftegrast ophthalmic solution 5% (Xiidra, Bausch + Lomb).⁴

Treat the lipid layer
Meibomian gland dysfunction (MGD) is prevalent in 30% to 60% of contact lens wearers and is a significant contributor to contact lens discomfort.⁵ To improve meibomian gland function, consider both at-home and in-office therapy options. Regarding the former, warm compresses, eyelid hygiene (lid scrubs), artificial tears,⁶ and omega fatty acid supplements^7,8 fit the bill.

For the latter, a single-vectored thermal pulsation treatment,⁹ intense pulsed light,¹⁰ radiofrequency¹¹ with meibomian gland expression, intraductal probing, and debridement of meibomian gland orifices can be effective.¹²

Decrease the toxic load
Contact lens solutions can cause toxicity or hypersensitivity reactions manifested as conjunctival redness, punctate staining, or corneal infiltrates in patients who have DED.¹² Even at low concentrations, preservatives will cause some degree of cell damage to the ocular tissues.¹³ Therefore, recommending a contact lens holiday, daily disposable lenses, preservative-free lens care systems, and preservative-free rewetting drops can reduce this.

Vision for every day
Our patients desire clear and comfortable vision every day. This means addressing their ocular surface issues, if any. The strategies described above may enable your patients to wear their contact lenses for years to come. OM

References: 

1. Stern ME, Gao J, Siemasko KF, Beuerman RW, Pflugfelder SC. The role of the lacrimal functional unit in the pathophysiology of dry eye. Exp Eye Res. 2004;78(3):409-416. doi:10.1016/j.exer.2003.09.003

2. Mah F. Oral presentation at: World Cornea Congress VIII; September 28-29, 2022; Chicago, IL, USA.

3. Periman LM, Perez VL, Saban DR, Lin MC, Neri P. The Immunological Basis of Dry Eye Disease and Current Topical Treatment Options. J Ocul Pharmacol Ther. 2020;36(3):137-146. doi:10.1089/jop.2019.0060

4. Mukamal, R. Improved Dry Eye Drugs for 2022 and Beyond. American Academy of Ophthalmology. November 4, 2021. https://www.aao.org/eye-health/tips-prevention/new-dry-eye-treatments-ocular-surface-disease (Accessed Nov. 25, 2024)

5. Schaumberg DA, Nichols JJ, Papas EB, Tong L, Uchino M, Nichols KK. The international workshop on meibomian gland dysfunction: report of the subcommittee on the epidemiology of, and associated risk factors for, MGD. Invest Ophthalmol Vis Sci. 2011;52(4):1994-2005. Published 2011 Mar 30. doi:10.1167/iovs.10-6997e

6. Arita R, Fukuoka S. Non-pharmaceutical treatment options for meibomian gland dysfunction. Clin Exp Optom. 2020;103(6):742-755. doi:10.1111/cxo.13035.

7. Wang WX, Ko ML. Efficacy of Omega-3 Intake in Managing Dry Eye Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med. 2023;12(22):7026. Published 2023 Nov 10. doi:10.3390/jcm12227026.

8. Al Mahmood AM, Al-Swailem SA. Essential fatty acids in the treatment of dry eye syndrome: A myth or reality?. Saudi J Ophthalmol. 2014;28(3):195-197. doi:10.1016/j.sjopt.2014.06.004.

9. Blackie CA, Coleman CA, Nichols KK, et al. A single vectored thermal pulsation treatment for meibomian gland dysfunction increases mean comfortable contact lens wearing time by approximately 4 hours per day. Clin Ophthalmol. 2018;12:169-183. Published 2018 Jan 17. doi:10.2147/OPTH.S153297.

10. Toyos R, Desai NR, Toyos M, Dell SJ. Intense pulsed light improves signs and symptoms of dry eye disease due to meibomian gland dysfunction: A randomized controlled study. PLoS One. 2022;17(6):e0270268. Published 2022 Jun 23. doi:10.1371/journal.pone.0270268.

11. Paul S, Cohen A, Parsa K, Jaccoma E, Burrell K, Carruthers J. Transcutaneous Radiofrequency-mediated Meibomian Gland Expression is an Effective Treatment for Dry Eye: A Prospective Cohort Trial. The Open Ophthalmology Journal. 2023;17 ISSN 1874-3641, https://doi.org/10.2174/18743641-v17-e230328-2022-63.

12. Jones L, Downie LE, Korb D, et al. TFOS DEWS II Management and Therapy Report. Ocul Surf. 2017;15(3):575-628. doi:10.1016/j.jtos.2017.05.006.

13. Epstein SP, Ahdoot M, Marcus E, Asbell PA. Comparative toxicity of preservatives on immortalized corneal and conjunctival epithelial cells. J Ocul Pharmacol Ther. 2009;25(2):113-119. doi:10.1089/jop.2008.0098.

PAMELA E. THERIOT, OD, FAAO, is the clinical director of the Dry Eye Relief Center at Lusk Eye Specialists, a multi-specialty practice in Shreveport, La. In 2021, she was appointed to the Public Awareness committee of the Tear Film & Ocular Surface Society (TFOS). She created a Dry Eye Relief Blog that contains tips and product recommendations for dry eye patients.