Contacts and dry eye

[Rebecca Petris]

There have been a lot of comments lately about "contact lens induced dry eye" and so I thought I'd open a little discussion about this. I do not have any useful knowledge in this area myself, so I would love to hear from those of you who do.

I'll kick it off with a couple of comments:

FIRST, I am usually somewhat skeptical when I see anyone posting that "XXX caused my dry eyes". Dry eye is a complex, multi-factorial, progressive disease. I'm not saying it can't be pinned down - but I think there's frequently more to it than "thus-and-such caused it". I think we can benefit from differentiating between causes, and triggers, or things that exacerbate (or reveal) an underlying or longstanding undetected conditions.

Consider this: even in the case of LASIK, where there are multiple PROVEN mechanisms by which the surgery causes dry eye, for so many of us there's much more to it. So, how much more with other causes/triggers that are not scientifically proven like LASIK is.

I guess my point is, if we are too quick to dismiss dry eyes as contact lens induced... and setting aside for the moment the scientific questions about that... we may shortchange ourselves when it comes to treatment. For example, a common pattern might be mild chronic MGD causing contact lens intolerance over the years. Just because your eyes don't get better when you stop wearing lenses doesn't mean the lenses on their own did permanent damage - IF there is concurrent stuff going on.

SECOND, I was kind of puzzled when looking for medical literature to explain the connection between contacts and dry eye. After talking with various people I am sensing a little paradox, which perhaps I can explain with a little dialogue....

MD: Well of course contacts cause dry eye. Not in everybody of course but the people who have really heavy use of contacts for many years.... Chronic hypoxia, relative anaesthesia, eventually neurotrophic keratopathy.

OD: Sure. Show me the studies. Contacts have been around for an awful lot of years, and if this is the case, surely it's been studied.

MD: Well, uh, nobody publishes it because, well, we all just know it and it's something no one wants to prove. Y'know, like all those big contact lens companies.

OD: But....

MD (interrupting): Oh and by the way you're not entitled to an opinion because you make your living from contacts.

OD: I see. My bad. By the way, congratulations on your most recent LASIK study in the Journal of Refractive Surgery. I don't suppose it was funded by VISX was it?

[TRiBaL]

Ya i wore contacts since i was 14. Two years ago I stop wearing contacts because of my DES. Contacts just seem to aggravate the DES, but if your one those people that don't get dry eyes easy sure you will still get dry eyes with contacts but not often as people do with DES. I can't even wear my contacts anymore with having DES kinda sucks. Hopefully my DES will eventually get better some how .

[Dryeye22]

Here is some hopefully info:

Here is some info I found about the topic:


Contact lens induced dry eye occurs in some patients who may have had a marginally dry eye before they were fit with contact lenses or may actually be the result of contact lens wear. A normal and stable tear film is necessary in order to be a successful contact lens wearer who does suffer from symptoms of dryness and grittiness. To have good tear film stability means that the normal natural tear film is able to maintain itself in a fairly uniform layer on the cornea. Mother nature has provided us with a mechanism for achieving normal tear film stability in the form of certain anatomical features found on the outermost layer of the cornea, the corneal epithelium. The normal healthy corneal epithelium is covered with microscopic "hairlike" structures call microvilli. These microvilli act to provide a "roughened surface" for the normal tear film to adhere to and thus give it stability in between each time you blink your eyes. Unfortunately, over years of wearing contact lenses, it is believed that constant rubbing and movement of the contact lens across the surface of the cornea may in fact damage and deplete the presence of these epithelial microvilli resulting in a less stable tear film and contact lens induced dry eye symptoms. Again, this is not a sight threatening complication, but one that makes contact lens wear less comfortable and sometimes results in an inability to wear your contact lenses, even if you change lens materials and use lubricating eye drops. Once you have completely discontinued wearing your contact lenses, it is thought that the microvilli will resume their normal presence over some period of time and in most if not all cases, the tear film will return to normal.


I think i have a better chance of winning the lottery but hey u never know : )

[DrG]

Dryeye22, can you please cite the source for this information?

Also, if you would like to open a discussion on the topic, as opposed to simply asserting an opinion, feel free to post something in my forum on contact lenses.

[Rebecca Petris]

DrG, the Q&A forums are set up in such a way that there cannot be any interaction (discussion) other than responses by the individual who started the thread. I started this thread for group discussion without anything formal in mind... Opinions, anecdotes information, links etc are all welcome. But you are quite right that anyone quoting other sources needs to cite the source as per our standard forum rules.

[DrG]

You are absolutely right. I had forgotten that those restrictions were in place. My apologies.

By the way, I did find the source of the information here.

I don't necessarily agree with it, though.

[sazy123]

Hi its good this contact lense discussion has been opened.

For me i believe i have two pivital causes of my dry eye, first contact wear for 4 years but the dry eye was only mild and didnt bother me if i did not wear the contacts, then second antidepressants which sent it over the egde.
So contacts were not the sole cause of my dry eye but i do believe that if i hadnt developed marginal dry eye by wearing them, i wouldnt have got dry eye from antidepressants. As i did use antidpressants before i went on contacts and i was fine.

Im not saying everone gets dry eye from contacts, because obviously the majority wont. But people with dry eye and wear contacts do seem to be a higher % than the normal population. Going by the amount of people on this site who have worn contacts and have dry eye. Its alot, in everday life i dont know hardly anyone who even wears contacts, or who has dry eye for that matter. I dont know why this connection isnt studied, I havent seen many studies either. Well I dont think this connection would be a very popular one for contact lense industries if you know what i mean.

Unlike lasik it is not as ovbious that contacts could be a cause becuase its not like you put one contact in them bamm you get dry eye like lasik, its a more gradual thing. So with other things like menapause its hard to tell.

Once you have completely discontinued wearing your contact lenses, it is thought that the microvilli will resume their normal presence over some period of time and in most if not all cases, the tear film will return to normal.

Yeah right i discontinued them several times for months everytime i tried to wear them again i couldnt!

Oh i Did find this:

http://findarticles.com/p/articles/m..._n9178577/pg_1

Ocular dryness remains the most common complication associated with soft contact lens wear. Approximately four out of five lens wearers report symptomatic dryness during some portion of their wearing schedule. As a result, one out of four patients are forced to reduce their wear time; two million individuals abandon soft contact lens wear altogether each year with nearly 50% of these contact lens "dropouts" attributing dryness or discomfort as the primary reason. Keep in mind that the majority of the contact lens wearing population are young, healthy individuals. In this population, true aqueous deficiency or keratoconjunctivitis sicca (KCS) is extremely rare. Thus we have dry eye symptoms in individuals who, for the most part, have adequate tear production.

[Tony Barnes]

I haven't heard anything about the microvilli aspect, though that sounds interesting. Does anyone have any more on this??

However, the problems caused by the physical interaction with the lens and the tear film are well known and documented. I've attached some info on it.

It's reckoned that over 50% of all lens users experience dry eye symptoms to varying degrees - that's a lot higher than the general population average!

[brd888]

Everyone I know who wears contacts gets dry eyes if they wear them too long, especially at my workplace with air con and low humidity. However, I got a dry eye despite not needing contacts or glasses.
I think I had dry eye problems for a long time before I noticed a real problem - i.e. I always seemed to often get dust in my eye which was fixed by a quick rub or blink. I think this wasn't dust but a mild sudden episode of dry eye.

My point being maybe many people don't realise they have a dry eye (in mild cases). These people may wear contacts and notice the problem more and relate it to the contacts instead of the underlying dry eye problem.

Of course some other folk get dry eye caused by long term contact use which must be damaging the goblet cell layer (IMHO).

Bruce

[Tony Barnes]

I fully agree on the lack of knowledge of the issue - I've had mild dry eye for most of my adult life, and simply put up with it as:

1. It wasn't much of an issue to me at the time
2. I simply didn't know it was an actual condition!!

With regards to why people get it, I did a user survey the other week and found that over 40% of people who bought Clarymist didn't even know why they had dry eyes...

[DrG]

In survey after survey, dry eye symptoms are very prevalent in the adult population. With contact lens wear, the prevalence goes up to as much as 70% reporting some symptoms, typically later in the day. Clearly, contact lenses can be considered a stressor for the tear film -- much as air conditioning or low humidity, or act as a mild irritant which mimics the effects of dry eye. However, in the vast majority of cases, the symptoms abate upon discontinuation of lens wear.

In the population of patients I treat for dry eye, most of them have never been able to tolerate contact lenses. Then there is another group of patients who are typically female who wore contacts fine, but had problems after childbearing, suggesting more of a hormonal cause. Surprisingly, I come across a fair number of children with dry eye and some contact lens intolerance. That would be an interesting group to study.

In my nearly 25 year career, I have followed large numbers of patients wearing contact lenses, and I would think that I would have noticed a significant trend if contact lenses really did induce clinically significant dry eye. What I mean by clinically significant is that these patients not only must discontinue lens wear, but also suffer enough discomfort and observable pathology that ongoing treatment is required.

With respect to the microvilli factor, a quick search of the peer-reviewed literature indicates that loss of microvilli occurs in a number of dry eye states, but none has been reported in association with contact lens wear. In fact, the mechanism proposed in the article would seem to be invalidated by the fact that soft contact lenses move very little. If mechanical friction was a factor, one would think that the simple act of blinking would wear down the microvilli with the contact lenses acting as a protective barrier. So much for junk science.

[DrG]

For me i believe i have two pivital causes of my dry eye, first contact wear for 4 years but the dry eye was only mild and didnt bother me if i did not wear the contacts, then second antidepressants which sent it over the egde. So contacts were not the sole cause of my dry eye but i do believe that if i hadnt developed marginal dry eye by wearing them, i wouldnt have got dry eye from antidepressants. As i did use antidpressants before i went on contacts and i was fine.

So, you were on antidepressants before you started wearing contact lenses for X number of years, then a different or additional antidepressant with contact lenses for 4 years, for a total of X+4 years. Did anything else happen in your life during that time, other than the fact that you got a little older, which may have triggered this?

Im not saying everone gets dry eye from contacts, because obviously the majority wont. But people with dry eye and wear contacts do seem to be a higher % than the normal population. Going by the amount of people on this site who have worn contacts and have dry eye. Its alot, in everday life i dont know hardly anyone who even wears contacts, or who has dry eye for that matter. I dont know why this connection isnt studied, I havent seen many studies either. Well I dont think this connection would be a very popular one for contact lense industries if you know what i mean.

With due respect, I really think this is a red herring. Contact lenses have been studied to death, and there are any number of studies suggesting negative effects and complications of wearing contact lenses such as eye infections. However, so far there are none suggesting permanent clinical dry eye. The role of contacts in inducing dry eye sensations or symptoms has been studied for many years. I know first hand because I did a complete literature review in 2003 in preparation for a professional presentation at the Dry Eye Symposium at the annual CLAO meeting.

Contact lenses are very popular and I am not at all surprised that many of the patients on this forum have tried them at one time or another. In fact, I know many patients with dry eye who keep trying, hoping that the technology has improved, and it has.

Unlike lasik it is not as ovbious that contacts could be a cause becuase its not like you put one contact in them bamm you get dry eye like lasik, its a more gradual thing. So with other things like menapause its hard to tell.

Exactly.

[DrG]

MD: Well of course contacts cause dry eye. Not in everybody of course but the people who have really heavy use of contacts for many years.... Chronic hypoxia, relative anaesthesia, eventually neurotrophic keratopathy.

...and eventually death. Chronic hypoxia is reversible and relative anesthesia is reversible. If you do a search on neurotrophic keratopathy, you will find many studies in the use of bandage lenses to treat it.

MD: Well, uh, nobody publishes it because, well, we all just know it and it's something no one wants to prove. Y'know, like all those big contact lens companies.

...and those pesky little studies involving eye infections. Funny how that negative stuff still gets reported.

MD (interrupting): Oh and by the way you're not entitled to an opinion because you make your living from contacts.

....and you're not entitled to an opinion about anything LASIK because you make your living from performing it, or else your colleagues do.

OD: I see. My bad. By the way, congratulations on your most recent LASIK study in the Journal of Refractive Surgery. I don't suppose it was funded by VISX was it?

...gee, I would love to see some funding. Then I could complete my study on the effects of contact lens wear and dry eye I started in 2002.

[Rebecca Petris]

Surprisingly, I come across a fair number of children with dry eye and some contact lens intolerance. That would be an interesting group to study.

This is interesting - and worrying. Funny, I was talking with Sandra Brown about the same thing recently as she sees a great deal of MGD in her pediatric practice.

[Dryeye22]

Dr. G

I have a quick question about contact lenses for you.

I wore acquatech 55 for nine years. I have no medical problems, and was successfully able to wear the lenses for 16 hrs a day. However, after falling asleep in my contacts (12hrs) I woke up with severe dry eyes. Literally, it seemed overnight. Now I am severely acqueous defficient. Could I have damaged my nerves? Corneal Exhuastion Syndrome?

Thank you!

I just wonder because everyone suggests that contacts alone cannot cause dry eye but how do you explain this in a person who is completely healthy and never took any sort of drying medication?