Navigating the intricacies of dry eye management is a daily challenge, and when it comes to contact lens wearers, the plot thickens. As an optometrist specializing in diagnosing and treating dry eye, and the co-founder of Peeq Pro, I'm thrilled to share insights and practical tips to enhance your approach when addressing dry eye in contact lens wearers.
Contact lens wearers often present with distinctive characteristics that signal underlying dry eye issues. The most common signs include:
- Increased Tear Evaporation: Contact lenses can disrupt the tear film, leading to accelerated evaporation and subsequent dryness. This is seen as poor wettability of the lens surface.
- Reduced Tear Break-Up Time (TBUT): Contact lens wear can compromise the stability of the tear film, resulting in decreased TBUT.
- Lens Discomfort & Intolerance: Patients may complain of discomfort, blurred vision, or a gritty sensation, especially towards the end of the day.
Understanding these unique characteristics is crucial for a targeted and effective management strategy.
Grading Dry Eye Severity
Utilize a comprehensive approach to assess the severity of dry eye in contact lens wearers. Consider factors such as ocular surface staining, TBUT, and patient-reported symptoms. Classify severity into mild, moderate, or severe categories to tailor your management plan accordingly.
Individualized Treatment Plans:
- Mild Dry Eye:
- Recommend preservative-free lubricating drops for use before and after lens insertion.
- Implement lid hygiene.
- Encourage proper lens hygiene and solutions as well as educate on the importance of regular breaks from lens wear.
- Moderate Dry Eye:
- Explore daily disposable lenses to reduce the risk of deposit buildup and reduce exposure to the chemicals in multipurpose contact lens solutions.
- In addition to good lid hygiene, introduce lipid-based lubricants to enhance tear film stability.
- Consider adjusting lens materials based on individual patient response.
- Recommend Omega 3 supplementation.
- Severe Dry Eye:
- In building on the therapies initiated for mild and moderate dry eye, prescribe in-office therapies.
- Implement therapeutic options such as intense pulsed light (IPL) therapy and Thermal Pulsation to alleviate inflammation and improve gland function.
- Collaborate with the patient to establish a realistic wearing schedule that minimizes discomfort.
- Preservative-Free Artificial Tears: Choose lubricants specifically designed for contact lens wearers to reduce irritation.
- Lid Hygiene: Emphasize the importance of consistent lid hygiene to maintain meibomian gland health. Include warm compresses and gentle lid massage as core components. Introduce tea tree oil based foaming eyelid cleansers, hypochlorous lid solutions, warm compresses and gentle lid massage. Ensuring maximum debridement of the microbiome living along the lid margins can be achieved with the Peeq Waiva Cleansing System.
- Topical Anti-Inflammatories: Consider prescription medications like cyclosporine (Restasis) or lifitegrast (Xiidra) to address inflammation.
- Omega-3 supplementation may be a valuable adjunctive strategy for managing dry eye symptoms in contact lens wearers. By addressing inflammation, improving tear film stability, and supporting meibomian gland function, omega-3 fatty acids can contribute to enhanced ocular comfort for individuals using contact lenses.
- Intense Pulsed Light (IPL) Therapy: For severe cases, IPL therapy can provide significant relief by targeting inflammation and improving meibomian gland function. We use it in my office, and I am consistently pleased with its ability to treat even the most challenging patients.
- Thermal Pulsation: This therapy is designed to improve the function of the meibomian glands by applying controlled heat and pulsatile pressure to the inner eyelids. The goal is to liquefy and express the thickened and obstructed meibum, restoring the normal flow of oil from the glands.
In conclusion, managing dry eye in contact lens wearers demands a nuanced approach. Recognizing the unique characteristics, assessing severity, and formulating individualized treatment plans are crucial steps. From preservative-free artificial tears to advanced therapies like IPL and thermal pulsation, our arsenal is vast. Together, let's enhance the quality of life for our contact lens-wearing patients battling their dry eyes.
Wishing you clear visions and successful treatments,
Dr. Cheryl Chapman Optometrist and Co-founder, Peeq Pro