Dry Eye and Contact Lenses

Have you ever gotten home from a long day and thought, “My eyes are so uncomfortable! I can’t get these contacts out fast enough!”? Roughly 50% of contact lens wearers report this complaint, and if you relate to this sentiment, it is likely that you struggle with dry eye disease.¹ Dry eye disease is defined in the eye care community as a condition that is caused by many factors and results in tear film instability, visual changes, and discomfort.² It is a condition that can be managed with your eye care provider in many different ways, so it is vital that you bring these concerns to your provider’s attention. Your provider will perform a comprehensive examination of the front surface of your eye to determine the likely cause of your dry eye and formulate a treatment plan.

Dry Eye and Soft Contact Lenses

It is no secret that soft contact lenses can worsen existing dry eye disease, or in some cases even induce it.¹ This does not mean, however, that the discomfort cannot be managed. Treatment plans will often start with topical therapies, likely including over-the-counter artificial tears.² If this treatment does not yield an effective outcome, your provider may consider refitting your contact lenses into a more dry eye friendly option. For instance, if you are initially wearing monthly lenses, there is evidence to show that making the swap for a daily disposable lens option will improve dry eye symptoms and yield better end of day comfort.³ Additionally, the components of the contact lenses will be considered by your provider as some contact lenses better mimic the ocular surface than others, causing less disruption to the tear film, in turn reducing evidence of dry eye.⁴ If the dryness is still present after exploring topical treatment options and altering lens modalities or materials, your provider may recommend the discontinuation of soft contact lenses. Instead, you and your provider may opt for a gas permeable lens option like a corneal gas permeable contact lens, or in severe dry eye cases, a scleral gas permeable lens.

Contact Lenses as a Treatment for Dry Eye

In cases of severe dry eye, whether induced by contact lens wear or not, contact lenses can be used therapeutically. For example, soft contact lenses may be used to temporarily “bandage” or protect the surface of the eye from the mechanical distress of blinking, which can improve comfort.³ This treatment is often used in acute flare ups of dry eye disease that have caused significant surface damage and is generally not used as a long-term treatment option. For a more long-term treatment option scleral gas permeable contact lenses, or “sclerals” for short, may be considered. By design, a scleral lens is filled with fluid prior to insertion and thus acts as a liquid reservoir to bathe the cornea throughout the day. This prevents damage to the corneal surface caused by dry eye, helping to improve dry eye-related visual blur as well as dry eye induced discomfort.⁵ Additionally, scleral lens act as a barrier between the eye and the environment which is particularly helpful in severe dry eye cases such as filamentary keratitis, graft versus host disease, and Sjogren’s syndrome among others.⁵