Dry eyes with contact lenses is an extremely common occurrence and accounts for about 60% of our patients who are seeking vision correction surgery such as LASIK, PRK, ICL, RLE (refractive lens exchange) and Intraocular lens/Cataract surgery.
Dry Eye Symptoms with Contacts
As a Refractive surgeon (an Ophthalmologist (a Medical Doctor who has received four years of training in the surgery and pathology of the eyes in visual systems) I have a biased viewpoint. Virtually all of my patients are seeking a solution to a problem. The problem is inherently that the vision is blurry and requires glasses, contact lenses, or vision correction surgery to allow our patient to see clearly and function in the world. I estimate that 60% of our contact lens wearing patients have some degree of ocular discomfort due to contact lenses and dry eyes irritating their eyes. For our glasses wearing patient, they have glasses that don’t fit, fall off, get dirty, break, are forgotten, or are no longer the correct prescription for their eyes. Due to one or more of these problems, they come to our office seeking out a solution that will help them to see clearly without the hassle of glasses or contact lenses.
Irritation due to contacts is understandable because contact lenses sit on the surface of our eyes for 12 to 14 hours a day, every day for years or even decades. As with other artificial objects, our bodies sometimes reject the foreign object, in this case a contact lens. The two most common causes of ocular irritation with contact lenses are:
- Dry Eyes (aqueous insufficiency): a deficit of the aqueous or water portion of the ocular surface that then creates friction between the contact lens and the surface of the eyeball that causes foreign body sensation, redness, irritation, pain, and/or blurry vision.
- Giant Papillary Conjunctivitis (GPC): an allergic or hypersensitivity reaction to the contact lens material and/or the proteinaceous buildup on the contact lens surface. It is under diagnosed and often mistaken for “dry eyes.” GPC is a very common reaction especially in young people.
I had GPC myself after wearing contact lenses for 45 straight days when I was traveling through Europe in my early 20s as a student. After that, I could never comfortably wear contact lenses again and had LASIK when I was 32 years old-it’s fantastic!
This is typically how GPC presents. Someone who has worn contact lenses for many years may suddenly find that they are intolerant of the contact lenses. Their eyes are not typically irritated or “dry” when they are wearing glasses, but when they put on contact lenses, they get and intense irritation, redness and foreign body sensation sometime shortly after placing the contact lenses on the surface of their eyes. The cessation of the contact lens will alleviate the symptoms. Often times an optometrist will switch them to daily disposables. This can help but often does not alleviate the problem and the patient eventually stops wearing contact lenses and goes strictly to glasses. This is called contact lens failure and happens to a reported 3+ million people each year in the United States. This often leads to the patient seeking vision correction surgery, and we see them-Yay!-finally! They believe they have dry eyes, even though none of the testing suggests that. The problem is not dryness, but the contact lens material and the patient’s immune system. They are not compatible. This is one of the many times that LASIK or other vision correction surgery procedures can be a life-changing surgery allowing the patient to comfortably see without glasses or contact lenses
Possible Causes of Dry Eyes and Contact Lenses
The list of possible causes of dry eyes and contact lenses is a long one.
- Female gender: women are the primary people affected by ocular surface dryness. “Hormonal reasons” is the primary cause listed on papers dealing with the subject, but is woefully unsatisfactory as a reason.
- Certain medications that dry out the mucous membranes of our bodies. Any sympathomimetic, drugs for urinary incontinence, allergy medications, certain medications for depression such as Zoloft and similar medications.
- Auto-immune diseases such as arthritis, scleroderma, lupus, psoriasis, and sarcoidosis, among others.
- Hormonal deficiencies/menopause.
- Anatomical changes such as eyelid laxity, ectropion- which is where the eyelids turn away from the eye creating a dysfunction in the tear drainage apparatus and eyelid punctum.
- Eyelid abnormalities such as meibomian gland dysfunction. That is when the oil glands that line the margin of the eyelids get plugged up and no longer secrete the oil that prevents the water portion of our tear film from evaporating.
How to Treat Dry Eye Contacts
There are at least as many ways to treat dry eye contacts as there are to treat dry eyes without contact lenses. The simplest and generally easiest treatment for dry eyes is artificial tears. Artificial tears come in numerous brands, thicknesses, and formulations. They can be more water-like or more oil-like. After LASIK or PRK, our eyes are generally mildly or moderately dryer in the first 1 to 3 months. The ICL, RLE and IOL procedures generally do not affect the surface of the eye or make it dryer. Artificial tears can be used as frequently as one likes. They are not addictive and will not prevent your eyes from making their own natural tears. The artificial tears are limited in that they only correct the dryness from contact lenses for several minutes. They may need to be used very frequently. Often we recommend ophthalmic lubricating ointment to be used just before going to sleep. This will keep the surface of the eyes lubricated while you are asleep and allow you to feel better in the morning. Ointment is messy but very effective. I recommend running hot tap water over a tube of lubricating ophthalmic ointment for 20 seconds, or thereabouts, to soften it. The ointment is then placed inside the eyelid just before sleep because it will blur your vision significantly. In the morning, you can just wash your face normally and wash off the ointment that remains.
How to Avoid Dry Eyes Contact Lenses
Obviously, the way to avoid dry eyes from contact lenses is to not wear contact lenses! I am of course biased in this because I had LASIK surgery 25 years ago and love it. As I said earlier, I had GPC, a reaction to the contact lens material that prohibited me from comfortably wearing contact lenses. One does not need to abuse contact lenses to get GPC. It often just happens years after initiating contact lens use. There are no known contributing factors to the development of GPC other than total contact lens wearing time. To avoid GPC due to contact lenses, I recommend wearing them a shorter duration every day. Take them off when you come home from work or from whatever activity you are doing where you want to wear contact lenses. Let your eyes breathe, get oxygen to them, and definitely do not sleep in your contact lenses! This not only is a contributing factor to GPC, but can cause the development of a vision threatening corneal infection that can lead to scarring and loss of vision. The other strategy to avoid contact lens dry eyes, which is actually done for most people with GPC (an allergy to the contact lens material itself) is to wear daily disposable lenses. Throw them out every day. It is expensive, but can prevent dangerous eye infections and hopefully mitigate the risk of developing GPC. Or get vision correction surgery. That’s my vote!
Other Causes of Eye Irritation
There are many causes of eye irritation. I have listed the most common of them above, but environmental factors can also cause dry eyes contact lenses and ocular irritation. I always recommend wearing sunglasses when you are out of doors. The sunglasses serve multi-functions including blocking ultraviolet light rays to your eyeballs and the skin surrounding your eyes. No one wants to have basal cell carcinoma of the conjunctiva or eyelids, and blocking the harmful ultraviolet rays can reduce that risk. Sunglasses also prevent flying foreign bodies from landing in your eyes. You may not realize how often a pebble, piece of a leaf, dust or other foreign bodies may be flying towards your eyeballs and not get in. Our eyebrows, eyelashes, and eyelid apparatus with constant blinking wash away the foreign bodies most of the time without you even knowing that it happened. Sunglasses also protect from dry eye symptoms with contacts because they block some of the wind that will increase evaporation of the aqueous component of your tear film.
Contact Lenses for Dry Eyes
There are specialty contact lenses that are made specifically for dry eyes. There are some dissolving collagen contact lenses, as well as a very expensive contact lens to help the healing of the surface of your eyes. It is called Prokera and is generally limited to those who have debilitating ocular abnormalities or eyelid abnormalities that prevent the surface of their eyes from healing. Neurogenic dry eyes is a potentially severe problem in a very small number of people. This occurs when the facial nerve is damaged due to conditions such as a tumor, Bell’s palsy or other conditions that paralyze the 7th cranial nerve and our ability to blink. This can cause severe and vision threatening dryness of the surface of the eye that can cause the cornea to keratinize (become cloudy).
Best Contacts for Dry Eyes
The best contacts for dry eyes are generally no contacts. By that, I mean seeking out vision correction surgery, such as we do at SharpeVision MODERN LASIK and LENS. The risks, benefits, and expectations are discussed at length in your free comprehensive eye examination. You may schedule this online at sharpe-vision.com or call us at 425-451-2020 to schedule. The contacts themselves that I recommend if you have dryness are daily disposable lenses with a very high oxygen permeability content. Your optometrist can help you to choose the best brand for this. In addition, I recommend taking higher doses of fish oil which helps your eyelids to have the raw materials to create oil for your ocular surface. Warm compresses done nightly not only feel good, but can help to express the oil from your eyelids and keep it flowing. If you have plugged oil glands, you may see little off-white dots on the edges of your eyelids, or develop styes easily. See my blog post on styes and chalazion.
Best Treatment for Contacts and Dry Eyes
The best treatment for contacts and dry eyes is to figure out a way to see clearly without contacts or glasses. Fortunately there are superb choices for nearly anyone with glasses and contact lenses to see clearly without them. Regardless of age or amount of prescription, come see us at SharpeVision for your free comprehensive exam/LASIK consultation. Schedule with us online at sharpe-vision.com or call us at 425-451-2020. LASIK, PRK, ICL (see my blog post: https://sharpe-vision.
The second best choice for treating dry eyes with contact lenses is to wear glasses only. This is the safest option, as glasses can protect your eyes from projectiles, shade your eyes when it’s sunny, and can have bifocals built in to allow you to see near and far if you’re over 45 years old. Obviously, glasses are very limiting in that they must always be on your face. They can be uncomfortable, get dirty, broken, forgotten, or no longer be effective for your glasses prescription.
I hope this helps you understand dry eyes contacts lenses a little bit better. Dry eye symptoms with contacts are not always due to dryness but can be due to GPC, an allergic reaction to your contact lens material. If this happens to you, and it happens a lot, you may not ever be able to wear contact lenses comfortably for as long as you’d like. This is when LASIK and PRK become an even more appealing option- as if you need more appeal to live life seeing clearly without glasses and contact lenses!
Making glasses a thing of the past.