By addressing the etiology of the patient’s condition, you’ll increase the likelihood of successful lens wear.
When a patient complains of contact-lens-related dryness, you’ll first want to determine its degree and etiology to determine which of these options to recommend.
Preservative-free lubricating drops can be used in conjunction with contact lens wear without concern for preservative hypersensitivity or toxicity to the ocular surface. Available brands of preservative-free drops include Alcon’s Systane, Allergan’s Refresh Optive and Oasis from Oasis Medical, Inc., among others.
Punctal occlusion also enhances the lens wearing experience by increasing the patient’s natural tear volume via reduced outflow, and increasing the efficacy of lubricating agents by prolonging their residence time on the eye.
In cases of inadequate tear volume, patients may also benefit from a prescription agent such as Restasis (cyclosporine) from Allergan or Xiidria (lifitegrast) from Shire.
ADDRESS LID DISEASE
If the patient has lid disease or meibomian gland disease, you’ll likely want to select a lipid-based drop such as Systane Balance, Refresh Optive MEGA-3 or Retaine MGD from OCuSOFT.
Also instruct the patient to use warm compresses, such as the Bruder moist heat compress, and practice good lid hygiene. Consider an in-office treatment such as the Lipiflow Tear Activator from TearScience.
One agent I’ve found helpful for addressing lid disease and thereby enhancing contact lens wearability and comfort is Avenova with Neutrox from NovaBay. With 0.01% hypochlorous acid, this agent limits the microbial colonies on the lids and lashes. OCuSOFT also offers a lid scrub with 0.02% hypochlorous acid, namely OCuSOFT HypoChlor (hypochlorous acid 0.02%) Gel & Spray.
Patients who suffer from ocular allergy often find contact lens wear to be more problematic. Dryness and allergy often are interrelated, as a compromised precorneal tear film renders the patient more susceptible to allergic insult.
Topical antihistamines and mast cell stabilizers can help control the allergic response, thereby minimizing the negative impact of a contact lens in that environment. The prudent course is to minimize exposure to allergens; dilute allergens with a daily lavage of saline, and add an over-the-counter option such as Alaway (ketotifen) from Bausch + Lomb. For patients whose condition is recalcitrant to that treatment, there are a plethora of prescription antihistamines and mast cell stabilizers available. One convenient option is Pazeo (olopatadine), a mast cell stabilizer from Alcon that requires once-daily dosing.
THE WHOLE SITUATION
Any time a patient complains of dryness related to contact lens wear, look at the overall situation in the eye rather than assume that the contact lens is to blame. OO
Robert A. Ryan, OD, practices in a multispecialty practice at Flaum Eye Institute, University of Rochester Medical Center.
WHERE TO FIND IT:
800.451.3937 | Alcon.com
800.347.4500 | Allergan.com
Bausch + Lomb
800.828.9030 | Bausch.com
888.827.8337 | Bruder.com
800.890.0329 | NovaBay.com
800.233.5469 | OCuSOFT.com
Shire US Inc.
800.828.2088 | Shire.com
919.459.4880 | TearScience.com