CLINICAL: Contact Lenses

Provide Relief for Silent Sufferers

Identify ocular surface disease in those patients who are contact lens wearers

Contact lens wearers who also have dry eyes can be difficult to correctly identify. In my experience, many of them are silently suffering with their contact lens wear. Correctly identifying them as having an ocular surface issue can change the course of these patients’ contact lens-wearing experience. The ability to search for ocular surface disease (OSD), identify the issue and correctly treat the patient can separate an average contact lens clinic vs. a growing contact lens clinic.

Let’s look closely for ocular surface dryness signs via sodium fluorescein, with a Wratten filter.
Image courtesy of Dr. Jason Miller.


Actively searching for contact lens patients who have dry eyes begins with prompting the patient to offer issues by using the correct questions:

  • “On average, at what time during the day do your contact lenses begin to feel uncomfortable?” Another option: “When do you remove your lenses at night?” I often expect to hear a time earlier than they desire. If they answer “7 p.m.,” I follow-up with: “Would you prefer to wear your lenses longer than that?”
  • “Do you ever experience intermittent blurred vision throughout the day? If so, how often does this occur?” This is often evident during the refraction as well, when the patient is struggling to make a choice on the clearer lens option.
  • “Do you feel like you need eye drops throughout the day to help with the comfort and clarity of your contact lenses?” The patient may just feel like it is normal to have to carry around eye drops to help with their contact lens comfort.

Also, we should perform the right clinical procedures. Let’s look closely for ocular surface dryness signs via sodium fluorescein (utilized with a Wratten filter, as seen in the photo) and lissamine green vital dyes. These techniques can reveal undetected underlying dryness quickly.

Any signs of underlying dry eye disease (DED), a form of OSD, needs to be identified and treated to achieve your goals.


There are many ways to classify these patients, but I prefer to keep it simple.

  • Mild. These patients have intermittent contact lens-related dryness symptoms and /or little-to-no clinical signs.
  • Moderate. These patients have a history of having more consistent dry eye symptoms, along with mild clinical signs on the ocular surface.
  • Severe. These patients also have consistent symptoms, along with advanced clinical signs, for example, advanced ocular surface staining, meibomian gland dysfunction and rapid TBUT.


Obviously, treatments vary depending on the severity of the ocular surface condition. (See “Educate on DED Therapeutics,” p.24.) However, every path begins with patient education about the condition. Patients should understand why dryness needs to be treated and why those treatment options may evolve if things do not improve as expected. O.D.s should consider developing their own dry eye starter pack, which may include some relief options for mild silent sufferers, and ramp up their treatment options from there.


Contact lens-related dry eye patients are often hiding. They don’t really know they have a problem unless their O.D. finds, identifies and treats their condition. Take an active role in finding these silent sufferers. OM