Contacts and dry eye

[DrG]

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?

Nerve damage just seems so unlikely. What else is missing from this picture? Wrong diagnosis? Personally, I cannot recall a case like this in my practice. Not saying it couldn't happen, but it just doesn't fit in with my experience.

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?

If there is one rule in medicine, it is that there is an exception to every rule.

[Rebecca Petris]

This is a very interesting question and not just about contacts either.

There are many cases reported here of people going terribly - and persistently - dry literally from from one day to the next, both on the board and in calls I get. In most cases there seems to be an 'obvious' immediate trigger and in most cases that trigger does not sound like it would by any means fully explain things - but at the same time there doesn't seem much else to point to.

In these cases the patient usually gets told something like "well I don't know what caused it but it can't have been just X" which for the most part is not unreasonable, but still highly unsatisfactory.

[calli66]

Thanks Tony, for the link to the article "Tear Film Lipid Layer." I agree with the part about tear film and lens-wear with goggles over them--that's an affirmation of what I experience.

And the micro-villi damage angle--intriguing.

As always, I am interested in this topic, because I have dry eyes and I continue to wear contacts (although it has become a challenge to find comfortable brands). Reading about Sazy's experience and reading comments by Dr Latkany have made me question whether I should continue lens-wear. Reading Dr G moderates that--and I continue to try. We're all influenced by each other's knowledge, and that's a good thing.

I have yet to have an thorough and accurate diagnosis of my dry eye. No specialist has done more than the Schirmer test, and I since I can control the worst of my symptoms, I don't bother investigating it further.

I wish sometimes that I could be in a research population---testing my condition and testing possible contact lens improvements/ designs.

As for myself, I wore contacts from the age of 18-20 (the old, hard ones), and pretty much mistreated my eyes. Wore them too long, wetted them with saliva, etc.

My dry eye started in my mid-twenties, after moving to a dry climate. I wore no contacts again until I was 33. I wore different soft contacts off and on till I was 49--again, not a good patient. Used too much saline (for dry eye relief), was sort of unsanitary at times.

Wore glasses till I was 53 (minimal dry eye symptoms), then got back into contacts (preference for better acuity). I still find that contacts "protect" my eyes (they feel less dry with them in), but---I find them irritating/ unwearable under some conditions (when I'm really tired, while driving long distances, while hiking all day).

Sorry this is so long. My point is that my own experience is mixed. My eyes seem to be dry for several reasons, and maybe lens wear is one--and maybe it's not.

C66

[DrG]

In all honesty, I never did interpret my purpose on this website as one of contact lens advocacy. I know that contact lenses can cause damage to the eye. I have seen it happen. But, in almost all cases, there is some other underlying cause. I'm thinking now of a patient who was told by a corneal specialist that she had developed "contact lens allergy." He then did LASIK on her and she has full blown dry eye in addition to the usual assortment of post-LASIK night vision problems. In my opinion, she did not have a contact lens allergy, she had keratoconjunctivitis sicca which I documented in her chart.

The bottom line is that if contact lenses are uncomfortable to wear because of dry eye, or for any reason, quit wearing them and go back to eyeglasses or just wear them for special occasions or on a limited schedule. Problems occur when the envelope keeps getting pushed and the corneal epithelium says "enough already."

[sazy123]

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?

This can happen, a guy from this site markL, Wore his contacts with not much problem. He had no previous dry eye problems then One night he fell asleep in the his contacts and woke up with full blown dry eye (aqeous deficency) for 5 years, had to quit his job move away from the city etc. Then he found a solution in restasis and after 8 months his dry eye improved alot.

DRG:
I do have mild papilary (sp?) allergies, so this could have contributed to the contact lense intolerance. Or maybe the allergy/lid interaction with the contacts triggered dry eye, i dont know. But i am yet to find an allergy drop that has helped with my dry eye symptoms.

I went on antidepresants for 2 weeks when i was 15. So its probaly not anything significant. Then i started wearing contacts after this (first i had no problem wearing them), my tolerance became less and less until i gave up when i was 19, i presumably developed mild dry eye by whatever means. Then about a year later i went on antidepressants for 1 month and bamm severe dry eye and blepheritis.

And im not saying contacts were the sole cause, but i deffinately think they at least contributed or maybe put me at a higher risk for dry eye.

TBH i dont really care about the cause, all im interested in is a solution! But thought i might find that easier if i know the cause.

[sazy123]

In the study tony posted

This is interesting, i think this is the MG reduced output theory i was wondering about..

A reduction in the number of functional meibomian glands or meibomian secretion volume is also correlated with an increase in osmolarity, presumably ue to increased evaporation from a compromised lipid layer.

Also interesting

Contact lense wearmay alter these blinking parameters and thus potentially affect the quality of tear film lipid layer

[Dryeye22]

This is a response from Dr. L about contacts :

Response from Dr. L

--------------------------------------------------------------------------------

(Because of a temporary problem which precluded Dr. L. from answering directly, I've copy/pasted his response from a separate thread.)

It sounds like your ophthalmologist has a better chance of making an income from the lottery than as an ocular surface specialist.

Once again without ever examining you it is hard to say. However, I would bet you a lotto ticket that you are dry because you "deadened" your nerves from your chronic contact lens use. It is called "neurotrophic keratitis" and I deal with 10 or so patients a day between 25 and 35 who have worn lenses "comfortably" for 10 to 20 years and now "all of a sudden" their eyes are miserable. What happened was that their nerves have been silenced where they cannot sense their eyes are dry and therefore their reflex to make tears does not fire. Meaning they are making fewer tears because they think their eyes are fine but in fact they are dry and intolerant to contacts.

Aside from my over 40 female this is one of the next most common groups of patients I see.

For some reason it is rarely talked about but extremely common.

A teenager should be made aware of the future risks of wearing contacts!

Dr L

[sazy123]

Where was this post i think i missed this one?

It is called "neurotrophic keratitis" and I deal with 10 or so patients a day between 25 and 35 who have worn lenses "comfortably" for 10 to 20 years and now "all of a sudden" their eyes are miserable.

Is it possible neurotrophic keratitis could interfer with the reflex to make meibium as well as aqeous? I just read it can effect the aqeous component:
http://www.emedicine.com/oph/topic106.htm

What happened was that their nerves have been silenced where they cannot sense their eyes are dry and therefore their reflex to make tears does not fire. Meaning they are making fewer tears because they think their eyes are fine but in fact they are dry and intolerant to contacts.

I have to say this does make alot of sense. It Especialy makes sense for me when i relate it to my theory of face pain stimulating the nerves which tell my eyes to make tears agian. like the on/off switch. Dr L said:

The 5th(sensory) and 7th(motor) nerves supply the face and eyes/eyelids
so it is certainly possible that the two are connected.

It was actualy Dr Latkanys comments about contact dry eye and young people that got me thinking about this connection.

The fact that its rarely talked about, prob means we have a long time to wait

A teenager should be made aware of the future risks of wearing contacts!

I agree with this, i was not made aware of any risks.

Oh and Dryeye22, your previous post said you get face pain, How so? and are you experiancing what i experiance in terms of complete dry eye relief?

[Dryeye22]

Hey Sazy,

The pain is around the sinuses but I don't have any sinus problems. I find my eyes are whiter and less dry when I have the face pain.

[Dryeye22]

Sazy,

I just remembered in another post Dr. L talked about how a few patients had MGD and used contacts. He said that it might be more going on, and its not typical finding in contacts. Look through his old links and you will find a few things.

I think if dry eye is soley contact lens induced than it may get better when the contacts are removed. (I mean if peoples nerves grow back after being zapped by a laser why can't it from contacts) Who knows? I was having constant burning pain, and not being able to open my eyes in the morning and after removing my contacts for a month I am almost normal.

I think we really have to start publicizing this problem more! When you look at studies for dry eye most patients are 30 or older. We need to somehow relay our symptoms to people who actually know how to fix this problem from many different angles.

I just graduated with a degree in biology. This whole damn thing makes me want to be an opthamologist and try to fix everyone!!

NO ONE KNOWS HOW ANNOYING THIS IS UNTIL THEY EXPERIENCE IT THEMSELVES...

sorry for the mini rant!!

[DrG]

I, too, see people who were able to wear contact lenses comfortably for 20 years and then hit the wall. Most of them are female, and most of them are in their mid-30's and 40's. To say that their nerves have been "silenced" is hyperbole to say the least. The nerves don't die. In fact, I've had people who wear their lenses for weeks at a time report that their eyes feel more sensitive upon lens removal. Many report that their eyes are more light sensitive while wearing contact lenses. Does this suggest that their corneas have greater sensation?

The corneas of long-term contact lens wearers do become somewhat less sensitive, but they do not become anesthetized. Furthermore, this effect is minimized if lenses with high oxygen permeability are used, such as silicone-hydrogels. Most of these studies date back to the days when low DK lenses were the rule and RGP lenses weren't invented. Studies also show corneal sensation returns to baseline upon discontinuation of lens wear.

There is always a need for an additional study, but the word has long been out that contact lenses increase they symptoms of dry eye, but only while they are being worn. The industry has responded with better lenses for dry eye patients. In fact, I get about one referral per week from one of the major cancer centers to treat the patients who acquire severe dry eye from graft versus host disease. They think I am a miracle worker. I'll tell you my secret. I put them in a silicone hydrogel lens and make them use artificial tears. Their corneas heal up in a week.

[Dryeye22]

DrG,

Do you think it is possible that I will be able to wear contacts again? I figure if I give my eyes a break for a while and maybe restore my tear film I will be okay. It just sucks right now. I mean I have only worn contacts for nine years (22 yr old female) and I did sleep in them occasionally but other than that I did all the maintainance and had regular checkups and the doc said i was fine. Would the doctor be able to tell if my corneas "hit the wall"?

Thank you for all your time!

[DrG]

Do you think it is possible that I will be able to wear contacts again? I figure if I give my eyes a break for a while and maybe restore my tear film I will be okay. It just sucks right now. I mean I have only worn contacts for nine years (22 yr old female) and I did sleep in them occasionally but other than that I did all the maintainance and had regular checkups and the doc said i was fine. Would the doctor be able to tell if my corneas "hit the wall"?

I still think that I am lacking some information about your case, but I can think of a case of a young male patient of mine in his early teens who developed severe corneal surface disease and hypoxia. He didn't sleep in them, but persisted in wearing them despite the problems. They were the standard 55% water lenses similar to yours. Well, we took him out of the lenses and treated him with a course of steroids. When everything looked clear, we put him back into a very high DK Focus Night and Day and he hasn't had any trouble since.

I have commented before on how the contact lens industry may have created an epidemic of contact lens problems with those mid- to high-water hydrogel lenses with the intent of raising oxygen permeability. In a marginally dry eye, those lenses tend to cause the most dry eye symptoms. Then, when they dry out, the oxygen permeability drops, and the patient develops hypoxia on top of the dry eye. The newer silicone-hydrogel lenses have pretty much eliminated that problem.

[ihatedryeye]

In heinsight i would have stuck to my glasses. For me untill someone shows me any different or other really plausable reason why i could have dry eye i will believe contacts caused this problem, as i am otherwise healthy, and i dont think its unreasonable to think this- i am also a big believer of things that are unnatural for the body can cause harm. I have friends with allergies and use allergy eye drops on occassion. But they dont have these horrible continuous symptoms of dry eye. They get some itchyness which is usually relieved by allergy drops. Just using that as an example. I also know a few people with autoimmune diseases like lupus which can effect the eyes and dry eye, but they say their eyes feel fine. What im saying is that most people wont develop dry eye from a particular cause but i also think there is a percentage that will. And theres obviously a percentage of contact wearers that have dry eye caused by contacts. How big this percentage is is obviously unclear. But due to the popularity of contacts, it might be big enough to effect alot of people, like lasik does. just my two cents worth.

[ihatedryeye]

I have commented before on how the contact lens industry may have created an epidemic of contact lens problems with those mid- to high-water hydrogel lenses with the intent of raising oxygen permeability. In a marginally dry eye, those lenses tend to cause the most dry eye symptoms.

Well these were the contacts i wore, daily throw away. I think they were quite high water content. At the time I was told they were better for the eye because they were more hydrating and cleaner to use becuase you just throw them away. What kind of problems would they have caused, long lasting dry eye? Is this hypoxia long lasting?

After my eyes were developing dry eye problems i did try to change to ones which was supposed to be better for dry eye (lower water content), guess the damage was already done these werent much better either.