Article

CLINICAL: CONTACT LENSES

ASSESS THE LID RELATIONSHIP

Identify and treat eyelid problems, which can affect contact lens comfort

The eyelids and contact lenses have a unique relationship. For example, too much contact between the two causes irritation. Similarly, an infected eyelid can cause discomfort with the patient’s contact lenses. And, dysfunction of the meibomian glands, members of the eyelids, can cause a complete break up between your patient and his contact lens.

Here is how to foster a healthy relationship between your patient’s eyelids and his contact lenses.

1 IDENTIFY

The meibomian glands may be the most important factor in determining success with contact lens wear because of their close contact. Therefore, evaluate the quantity and quality of meibum secreted from the glands of all contact lens wearers.

The anterior and posterior surface of the eyelids also warrant significant attention, as disease on either will often harbor inflammatory events. Patients may complain about burning or irritation and/or fluctuating vision due to a poor tear film. Therefore, careful evaluation with the slit lamp, sodium fluorescein (NaFl) and lissamine green vital dyes provide valuable insight into eyelid disease.

Also, note that these symptoms are exacerbated while on digital devices, which cause poor blinking habits, so ask questions to gauge the patient’s screen time and timing of discomfort.

Lissamine green staining along the posterior surface of the eyelid can indicate a potential concern with regard to comfortable contact lens wear.

Subtle MGD with capping of glands along the lid margin.

2 TREAT

Aggressively treat the source of the issue. There are many treatment options for the eyelid, depending on the diagnoses. These treatments range from non-pharmaceutical to pharmaceutical interventions.

  • Non-pharma treatments: Eyelid hygiene, of which there are numerous options, aimed at improving the flora along the eyelid margin and heat, through hydrating heat masks, provide significant symptomatic relief. The goal with these products is to open the meibomian glands to deliver the highest quality meibum to the ocular surface.
    In-office treatments, such as meibomian gland expression and thermal pulsation systems, such as LipiFlow (Johnson and Johnson Vision) and MiBo Thermoflo (MIBO Medical Group), may prove beneficial.
  • Pharma treatments: Ocular nutritional supplements, antibiotic-steroid combination eye drops, anti-inflammatory eye drops and oral antibiotics are helpful in cases of acute severity of the eyelid disease.

PROVIDE FOR HEALTHY LIDS

The health of the lids is certain to affect the comfort of contact lenses. It is incumbent on the contact lens practitioner to identify potential eyelid problem areas and treat accordingly. This will maximize the likelihood of comfortable contact lens wear for your patients. OM

Photos courtesy of Dr. Jason Miller.