In the last contact lens department (see Look for small signs to prevent contact lens complications), I reviewed complications specific to contact lenses. Another aspect to consider is the underlying conditions that are amplified by the patient’s contact lens wear. Many ocular conditions can occur with or without hyperemia.
“Red eye” is a nonspecific term used to describe an eye that appears red due to illness, injury, or another condition in which the vessels enlarge as a defense mechanism.
When an OD sees a contact lens patient with a red eye, the first thought might be of contact lens-related concerns. But we must keep an open mind to other etiologies, such as these underlying—seemingly unrelated—causes, or even posterior segment problems.
A long list of causes of varying severity can lead to the same symptom of redness. Keep your staff informed to help you triage, especially when you are out of the office.
Patients should always be instructed to remove contact lenses when any degree of redness, discharge, or discomfort is present. Let’s start with the obvious: dry eye disease.
Dry eye disease
Dry eye disease has been documented as four times more prevalent in patients who wear contact lenses,1 with two-thirds of contact lens wearers being female.2
In fact, 50 to 90 percent of contact lens wearers report having symptoms of dry eye.3,4 The average onset of dry eye symptoms is nearly 10 years sooner in contact lens wearers at age 27 compared to age 36 in non-lens wearers.5
Of course, dry eye is an encompassing term. Whether the patient has a lack of water or a lack of oil, the loss is magnified when the tear film is split in two by the contact lens, resulting in a significantly reduced tear breakup time (TBUT) and tear volume for contact lens wearers.6
In fact, 59 percent of contact lens wearers were tested to be hyperosmolar in a 2017 study.7
Typically, when ODs see a low tear meniscus height or obtain a short phenol red thread test or Schirmmer’s test, they assume there is sluggish aqueous function.
An OD can utilize lissamine green to identify staining on the upper lid, indicating lid wiper epitheliopathy. This indicates low tear volume and friction against the ocular surface.
Excessive staining on the lower lid margin is assessed as the line of Marx and can represent keratinization and meibomian gland disease.8
To note, it is important to use enough lissamine green dye and to tap it along the lower lid margin before asking the patient to blink. If you fail to see a fine line at the mucocutaneous junction, you need additional dye.
Contact lens wearers are more prone to have meibomian gland dysfunction (MGD),9-12 and symptomatic contact lens wearers often show signs of MGD.13 It is critical that ODs carefully screen for this in every contact lens patient in order to promote long-term comfortable contact lens wear.12
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2. Centers for Disease Control and Prevention. Healthy contact lens wear and care: Fast facts. Available at: https://www.cdc.gov/contactlenses/fast-facts.html. Accessed 1/14/19.
3. Nichols JJ, Ziegler C, Mitchell GL, Nichols KK. Self-reported dry eye disease across refractive modalities. Invest Ophthalmol Vis Sci. 2005 Jun;46(6):1911-14.
4. Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. 2007 Feb;26(2):168-74.
5. The price of your device. National Eye C.A.R.E. Survey. Harris Poll. Available at: https://www.shire.com/-/media/shire/shireglobal/shirecom/pdffiles/media%.... Accessed 1/14/19.
6. Glasson MJ, Stapleton F, Keay L, Sweeney D, Wilcox MDP. Differences in clinical parameters and tear film of tolerant and intolerant contact lens wearers. Invest Ophthalmol Vis Sci. 2003 Dec;44: 5116-5124.
7. Bowling E, Bloomenstein M, et al. Prevalence of abnormal tear film quality and stability measured by abnormal tear osmolarity among contact lens wearers. Poster presented at American Academy of Optometry annual meeting, 2017. October 11-14, 2017; Chicago.
8. Yamaguchi M, Kutsuna M, Uno T, Zheng X, Kodama T, Ohashi Y. Marx line: fluorescein staining line on the inner lid as indicator of meibomian gland function. Am J Ophthalmol. 2006 Apr;141(4):669-75.
9. Arita R, Itoh K, Inoue K, Kuchiba A, Yamaguchi T, Amano S. Contact lens wear is associated with decrease of meibomian glands. Ophthalmology. 2009 Mar;116(3):379–84.
10. Ong BL. Relation between contact lens wear and meibomian gland dysfunction. Optom Vis Sci. 1996 Mar;73(3):208-10.
11. Korb DR, Henriquez AS. Meibomian gland dysfunction and contact lens intolerance. J Am Optom Assoc.1980 Mar; 51:243-251.
12. Paugh JR, Knapp LL, Martinson JR, Hom MM. Meibomian therapy in problematic contact lens wear. Optom Vis Sci. 1990 Nov;67(11):803-6.
13. Machalińska A, Zakrzewska A, Adamek B, Safranow K, Wisznewska B, Parafiniuk M, Machalinski B. Comparison of morphological and functional meibomian gland characteristics between daily contact lens wearers and nonwearers. Cornea. 2015 Sep:34(9):1098-104.
14. Kislan, T, Debello M. Effect of cyclosporine therapy on ocular surface heath, comfort and duration of CL wear. Poster presented at American Academy of Optometry annual meeting, 2016. November 8-13, 2016; Anaheim.
15. Blackie CA, Coleman CA, Nichols KK, Jones L, Chen PQ, Melton R, Kading DL, O’Dell LE, Srinivasan S. A single vectored thermal pulsation treatment for meibomian gland dysfunction increases mean comfortable contact lens wearing time by approximately 4 hours per day. Clin Ophthalmol. 2018 Jan 17;12:169-183.
16. Argilés M, Cardona G, Perez-Cabre E, Rodriguez M. Blink rate and incomplete blinks in six different controlled hard-copy and electronic reading conditions. Invest Ophthalmol Vis Sci. 2015 Oct;56(11):6679-85.
17. Gomes JAP, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, Kim T, Mehta JS, Messmer EM, Pepose JS, Sangwan VS, Weiner AL, Wilson SE, Wolffsohn JS. TFOS DEWS II iatrogenic report. Ocul Surf. 2017 Jul;15(3):511-538.
18. O’Dell L, Sullivan AG, Periman L, Halleran C, Harthan J, Hom M. An evaluation of cosmetic wear habits correlated to ocular surface disease symptoms. Association of Vision and Research in Ophthalmology Annual Meeting; May 6-11, 2017; Baltimore, MD. Available at: https://www.researchgate.net/profile/Milton_Hom/publication/316657827_An.... Accessed 1/15/19.
19. Porazinski AD, Donshik PC. Giant papillary conjunctivitis in frequent replacement contact lens wearers: a retrospective study. CLAO J. 1999 Jul;25(3):142-7.