Article Date: 7/1/2004

contact lens management
Beating the Dry Eye Beast
This run down of dry eye treatments reveals what methods work best.

As a contact lens specialist, I'm always concerned about patients who decide to stop wearing their contact lenses. I often find that this happens not because the patient wants to stop wearing them, but because of factors such as discomfort, poor fit or dryness. I'm thrilled if I can keep patients happy by helping them wear their lenses as long as they wish.

Here's the tricky part

While I can almost always improve comfort or fit, dryness has been a difficult problem to tackle -- in part because a dry eye state is inimical to successful contact lens wear. Dry eye occurs when a person's eyes don't produce the right amount or the right quality of tears, resulting in an unstable tear film. Unfortunately, a stable tear film is essential to successful contact lens wear.

Contact lens-induced dryness has been further troubling because there haven't been many available treatments to help solve this dilemma -- aside from trying contact lenses with different water contents. Dry eye sufferers generally welcome artificial tears, though they do suffer occasional symptoms. But those who have chronic symptoms often become frustrated with artificial tears after a short time, finding that they need to use them frequently to feel relief.

Restasis helps restore stability to the ocular surface.

Avoid occlusion

I avoid using punctal plugs because of the risk of excess tearing, which essentially leads to the pooling of unhealthy tears on the eye's surface. This possible "side effect" of punctal plugs can create the exact opposite of its intended goal of relieving the patient's feelings of pain or burning -- and can make wearing lenses unbearable.

Give them stability

In my past clinical experience, if I was unable to provide a patient with any long-term relief, then I would recommend that the patient stop wearing lenses altogether. Now with the availability of topical cyclosporine (Restasis), we have a tool to restore much stability to the ocular surface. Restasis improves the tear film with the production of natural tears and creates an environment conducive to wearing contact lenses. It's important to note that Restasis is safe for patients who wear contact lenses. We advise patients to wait about 15 minutes after instilling Restasis before they insert their contact lenses.

Identifying improvement

Contact lens patients who need to use artificial tears more than four times each day benefit from the use of Restasis. In my practice, we've noticed improvement in one month, with continued treatment at three months and significant improvement in signs and symptoms at six months. I still instruct patients to use the artificial tears twice each day, giving them q.i.d. dosing. Remember that Endura is in Restasis. (I recommend artificial tears q.i.d. for all contact lens patients, as well as those who work on computers.)

We have also found "off label" value for corneal transplant patients, superior limbic keratoconjunctivitis, vernal conjunctivitis, LASIK pre-op keratoconjunctivitis sicca and LASIK-induced neurotrophic keratitis.

References available on request.



Optometric Management, Issue: July 2004