Contact Lenses for dry eye

[kdc66]

I have suffered from dry eyes for 20 years. The condition was manageable until I developed a case of conjunctivitis about 4 years ago. After the conjunctivitis case, I had pain in my left eye 24/7. After being double-plugged, then restatis, taking theratears nutrition and also Biotears; my eyes feel better. However, I stay have eye pain at various times.

My opthamologist indicates from a dry eye perspective where I used to have dry spots and a schimer's score of around 5 (three years ago); I now have a schimer's score of around 15 in both eyes, no dry spots and a tear film break-up time of around 7-8 secords. I have blepharitis but is under control. She believes I have eye pain but based on my current condition she can't explain why I should continue to be having pain.

I have read about the Boston Scleral Lens for the treatment of dry eye but due to expense, travel issues, and the chance it may not work; have been reluctant to try it. One concern is others have mentioned they have blepharitis and the BSL irritates their lids.

So my question is for someone with dry eye related to tear production and blepharitis, what various types of contact lenses can treat the symptoms of dry eye? In your opinion what would be the best lens for dry eye and have you had success treating dry eye with contact lenses. Thanks.

[DrG]

I have had some dramatic success stories using soft bandage contact lenses for severe corneal surface disease, where pain was a chief symptom, and corneal staining was also present. I don't have much experience using bandage contact lenses for pain only in the absence of any corneal surface staining. What you are describing may be some kind of post-viral neuralgia.

However, given your excellent tear scores, I think it would be a reasonable idea to give a soft bandage lens a try, as the lens actually increases the distance between the free nerve endings from the surface of the cornea, serving as a buffer. The financial cost of failure in this case would be minimal.

I have been told that the BFS has had some success treating pain symptoms with scleral lenses, and so you might send them an email.

[kdc66]

Thanks for the response. What contact lenses (brand name) would you recommend to therapeutically treat dry eyes and why?

[DrG]

I reach for the Focus Night and Day as my first choice because of the low (24%) water content and ultra-high oxygen permeability. The next choice would probably be a lens in a different classification like the Proclear. If the optical correction could not be achieved with a soft lens, then I would try to fit an RGP scleral.

[kdc66]

What treatment, other than a lens, could be used for eye neuralgia? I understant that antidepressants are used to treat neuralgia but some or most of these drugs would also decrease tear production. Also, what type of doctor would be best to treat this? A neuroligist or neuro-opthamologist? Thanks.

[DrG]

Neurontin or Tegretol are often used in treating neuralgia. More radical treatments involve partial nerve resection by surgery, or alcohol injection. The neurologist would be competent in this area. A referral to a neuro-ophthalmologist would also be appropriate, except that they are often difficult to find.