Dry eye should be classified into 2 categories; ‘true’ dry eye and ‘marginal’ dry eye.

‘True’ dry eye is the poor tear quality in most conditions or environments.  Most dryness symptoms and signs exist without contact lens wear.

‘Marginal’ dry eye is insufficient tears in certain conditions. For example during contact lens wear, dry environments such as air conditioning, central heating and windy areas. Only occasional and slight signs or symptoms of dryness without contact lens wear. Contact lenses sufficiently destabilize the tear film producing occasional symptoms and signs. Eyelid margin conditions such as blepharitis and meibomian gland blockages can induce dryness symptoms.

Causes of dry eye may include problems with tear film structure, tear production, ocular anatomy and/or blink characteristics (eyelids and bulbar conjunctival changes).

MANAGEMENT of contact lens-induces dryness

Contact lens wearers with no obvious signs but who complain of dry eye symptoms can only be managed by education, as limited options exists to increase ocular wetness. Such options are listed below.

Contact lens wearers should manage your wearing schedule and avoid wearing contact lenses:

  • excessively every day
  • too many days per week
  • in certain environments (e.g. excessive air-conditioning, central heating or when smoky, dry or windy)
  • during long periods of concentration (e.g. studying, reading, driving)

The following techniques can be used to lengthen tear break-up time and surface drying time.

  • Artificial tears up to five times per day. Or contact lens eye drop up to three times per day. Note that the effects are not long-lasting.
  • Remove and rehydrate lenses with saline or multipurpose solution in middle of wearing period.
  • Contact lenses should not be worn longer than recommended disposable period.
  • Regular lid therapy to prevent meibomian gland blockage.

The optimum lens type for the contact lens wearer experiencing dryness symptoms is not clearly established. Generally a low water soft lens will be the best for minimizing problems with dryness. However, dryness symptoms may still persist with low water content contact lenses. And I would say silicone hydrogel lenses is the best!

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