Of course, some patients truly are poor contact lens candidates. A contact lens is a physical presence that disrupts the tear film and promotes tear evaporation, and that spells doom for patients with severely, dry eyes. That is why you should perform a thorough slit lamp examination (including instillation of fluorescein and evaluation of the tear film, tear meniscus and meibomian glands) prior to contact lens application to rule out any marginal candidates.
Mild- to-in oderate dry eye patients, many of them contact lens dropouts, can become successful contact lens wearers with just a little attention to detail and TLC.
Dry Eye Fitting
When fitting dry eye patients with contact lenses, we all know the drill: choose the optimum contact lens material and replacement schedule, apply artificial tears/rewetting drops at regular intervals, limit wearing time and encourage frequent and proper blinking. Some practitioners recommend artificial tears ointment at bedtime, eight glasses of water per day, punctal plugs and supplements such as flaxseed oil. What is too often overlooked is contact lens solutions.
First of all, artificial tears/rewetting drops should be preservative free. Preservatives may disrupt the tear film. In addition, they can bind to deposits in the contact lens material, resulting in an imperfect surface over which tears will not flow smoothly. Dirty contact lenses produce the same problem. Always ask patients the details of how they clean their contact lenses and ascertain good compliance.
Lastly, eliminate preservatives in contact lens solutions. A nonpreserved solution helps improve lens cleanliness and decreases dry eye symptoms.
Choose the Right Solution
Advanced Medical Optics’ UltraCare is a hydrogen peroxide based disinfection system whose neutralizing tablet contains an ophthalmic lubricant. This adds an increased benefit to dry eye patients, provided that the lenses are not re-rinsed between disinfection and insertion.
CIBA Vision manufactures three H2O2-based solutions: AOSept, Pure Eyes and AOSept Clear Care. All are excellent, but I think AOSept provides the most thorough cleansing due to the Miraflow daily cleaner. However, this alcohol-based cleaner may cause eye and lens dryness if it is not completely rinsed from the lens. I prefer Pure Eyes for dry eye patients over both AOSept and AOSept Clear Care because of Pure Eyes’ gentle cleaner. AOSept Clear Care does not require a rubbing step for cleaning lenses, and dry eye patients need lenses with minimal deposition.
Another good option for these patients is a disinfection system that uses ultraviolet light, such as Purilens. Just make sure that the patient is filling the unit with preservative-free saline.
Do not hesitate to switch your dry eye patients to a more complicated or expensive care system, even with disposable lenses. If they are motivated to wear lenses, they will thank you for it. CLS
Dr. Gromacki has a specialty contact lens practice as part of a multi-subspecialty ophthalmology group in Fishkill, NY, and has served as a faculty member at the University of Michigan Department of Ophthalmology and Visual Sciences.
Contributor: Susan J. Gromacki