Wednesday, January 4, 2012

Contact Lens Dry Eye Syndrome- What Kind of Dry Eye Workup Should Your Eye Doctors Do!

Contact lens wearers often suffer from dry eyes.  A contact lens is designed to be biocompatible, yet it disrupts the normal tear film and creates tear loss and evaporation. Still, many customers are highly motivated, NS suffer in silence.  Prolonged dry eye conditions left untreated can created cornea damage, which may eventually require cornea transplants or blindness.
The problem with contact lens-associated dry eye is well documented. The frequency of contact lens related dry eye is about 50%, suggesting that about 17 million of the 35 million contact lens wearers in the United States alone are affected.1 Almost 77% of patients will discontinue contact lens wear at one time or another due to comfort issues..
So what  kind of dry eye workup will your eye professionals do to diagnose dry eyes?
Dry Eye Work-Up

So often, customer come to us complaining of dry eyes, and they indicate their eye doctors didn’t do any tests, or done a few and been told they have dry eyes.  What kind of tests should be done to diagnose dry eyes include:
1. Fluorescein staining of the cornea and conjunctiva, see if there are dry staining spots.
2. Tear Viscosity Test- also called “tear film break-up testing”, lissamine green staining of the cornea and conjunctiva.  Dispersion of the dye measured by a stop watch.
3. Schirmers or phenol red thread testing, and evaluate the tear volume- responsible by lacrimal glands.  Normal Shirmer’s test value should between 15-20 mm
4. Dry Eye Questionnaire:
a.  How often do your eyes have symptoms of dryness? (Never; Sometimes; Often; Constantly)
  1. How often do your eyes have symptoms of scratchiness? (Never; Sometimes; Often; Constantly)
  2. Do you experience these symptoms in the company of smokers (pubs, clubs)? (Yes or No)
Treat Tear Deficiencies and Tear Film Stability:

TheraLife Eye Capsules- highly recommended for both lacrimal gland (tear volume) and meibomian gland dysfunctions (tear thickness) deficiencies.  TheraLife Eye works from inside out to normalize cell functions to both lacrimal and meibomian glands intra-cellularly so that you get balanced, sustainable tears all day long.   This formula is unique, and protected by patents.  Try it today!
Treat Ocular Surface- Mybomian Gland Dysfunction

Second, treat ocular surface problems.. For many patients, developing dry eye is a normal part of the aging process and contact lens wear only pushes them prematurely into this problem. Without a stable and healthy tear film, the patient will fail with contacts lens wear. Assess meibomian gland function as healthy meibomian glands are necessary for a stable tear film.
Recommended procedure here is to start lid scrubs and warm compresses to treat plugged meibomian glands and blepharitis. Reevaluate your treatment regimen in several weeks before considering changing the contact lens solution or material. Contact lens patients may well function acceptably with some modifications in the patient's tear film health and lid hygiene.
Preservative-Free Rewetting Agents-
Be aware that frequent use of eye drops (more than 3-4 times a day make your eyes drier.

The liberal use of artificial tears and drops to provide e temporary relief for dry eyes. . Regular use of rewetting agents (every two to three hours throughout the day) will make eyes drier.  If you ever noticed that after applying eye drops, you feel like putting more in within 10 minutes.  This is a sign you are over using eye drops, preservative free or not.
Advice is to decrease his contact lens wearing time and to use preservative-free tear drops frequently to improve his tear film no more than 3-4 times per day. Non-preserved tears eliminate the risk of the lenses adsorbing what may be toxic preservatives found in preserved artificial tears. Preservatives may disrupt the tear film, but they can also bind to deposits in the contact lens material, resulting in an imperfect surface over which tears will not flow smoothly. Therefore artificial tears and rewetting drops used by our contact lens wearers should be preservative-free.
Learn more about Contact Lens Dry Eye
For additional information- see Dec. issue of Optometric Management.
Want to talk to a doctor?  Call toll free 1-877-917-1989 US and Canada. International (650) 949-6080

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1. Ramamoorthy P, Sinnott LT, Nichols JJ. Treatment, Material, Care, and Patient-Factors in Contact Lens-Related Dry Eye. Optom Vis Sci. 2008; 85(8): 764‑772.
2. Nichols JJ, Sinnott LT. Tear Film, Contact Lens, and Patient-Related Factors Associated with Contact [UTF-8?]Lens–Related Dry Eye. IOVS 2006; 47 (4): 1319‑1328.
3. Prichard N, Fonn D, Brazeau D. Discontinuation of contact lens wear: a survey. ICLC 1999; 26(6):157‑162.
4. CIBA Vision, data on file, 2005.
5. Pult H, Murphy PJ, Purslow C. A Novel Method to Predict the Dry Eye Symptoms in New Contact Lens Wearers. Optom Vis Sci 2009; 86 (9): E1042‑E1050.
6. Guillion M, Maissa C. Dry Eye Symptomatology of Soft Contact Lens Wearers and Nonwearers. Optom Vis Sci 2005; 82 (9): 829‑834.

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