A plethora of treatments are available when patients, particularly contact lens wearers, are assessed at disease onset.
Dry eye disease (DED) affects approximately 1.5 billion people worldwide and is the most common disorder of the ocular surface.1 But it doesn’t have to be debilitating, especially for patients who wear contact lenses.
The condition remains somewhat underdiagnosed—even as more patients are wearing lenses— and symptoms range essentially limitless, due to patients believing the symptoms they experience are normal and therefore do not report them to their eye care practitioner.2
Redness, burning, and gritty sensations are all common among patients with DED, as well as sensitivity to light, blurred vision, and the accumulation of water and/or mucus in the eye.
These symptoms are often most severe in those who wear contact lenses and can cause persistent irritation, pain, and decreased quality of life.
Characterized by a loss of homeostasis of the eye’s tear film and what some researchers have described as “a vicious cycle of corneal epithelial damage and inflammation,”3 DED is exacerbated by the amount of time that many adults spend looking at screens.
According to a 2018 Nielsen report, screen time has increased to more than 11 hours per day for the average American adult.4
In addition, the ongoing COVID-19 pandemic has put its stamp on DED by complicating underlying disease among patients who frequently wear face masks.
When one’s breath travels upward toward the eyes during masking, premature evaporation of tears can occur.
The pandemic has also led to more patients opting to wear contact lenses because their glasses fog when wearing masks, perhaps increasing current estimates by the CDC that 45 million individuals in the US wear contact lenses regularly.5
Related: Q&A: Pandemic's effect on dry eye patient numbers
These patients are, therefore, also more susceptible to lens intolerance—yet another adverse effect of DED.
Despite these troubling trends, today’s eye care practitioners have options for treating DED at various levels of severity when patients are appropriately assessed at disease onset.
The most common cause of dry eye in patients is meibomian gland dysfunction (MGD), which is typically treated with lid margin hygiene, the removal of the meibomian gland obstruction, and the reduction or elimination of inflammation.
The Tear Film and Ocular Surface Society (TFOS) defines DED based on 4 levels of disease severity.6
In the more severe forms, patients experience constant, disabling discomfort with accompanying symptoms such as marked conjunctival staining, severe punctate erosions, filamentary keratitis, corneal ulceration, trichiasis, keratinization, and symblepharon.
DED is also a leading cause of lens intolerance among patients who wear contacts, with symptoms typically including blurred vision, eye discomfort and irritation, eye fatigue, and the sensation of a foreign body in the eye.
To successfully prescribe contact lenses for patients living with DED, physicians must be able to optimize the ocular surface to promote lens tolerance.
If the ocular surface is compromised or the tear film is inadequate, contact lenses as a foreign body could exacerbate signs and symptoms.
The goal should be to reduce inflammation, restore stability to the ocular surface and the homeostasis of the tear film, and relieve any obstruction related to MGD.
General treatment algorithms are available from the TFOS,7 the Cornea External Disease and Refractive Society,8 and the American Society of Cataract and Refractive Surgery.9
Depending on severity level, the following modalities and products are also recommended for the care of DED and can be utilized collaboratively, depending on the patient’s response to treatment.
Related: Q&A: Factors to consider when treating dry eye patients
Scleral lenses are also an effective treatment approach, especially when utilized as a combination therapy. The tear film reservoir is typically a preservative-free saline between the eye and the lens that can be modified as a “cocktail” for DED when a preservative-free saline, artificial tears, serum tears, or Regener-Eyes is mixed with the fluid within the lens.
This is a benefit that is not available with any other type of contact lens.
Regarding regular contact lenses, Regener-Eyes is most effective when used approximately 10 minutes prior to applying and approximately 10 minutes after removing lenses.
When steroids are prescribed for more quick-acting relief, Regener-Eyes is effective as a transition due to its ability to lubricate the eye and reduce inflammation.
Steroids can work well for patients who are experiencing mild to moderate dry eye, but severe conditions require modalities that offer more long-term benefits.
It is important to determine the underlying condition of the dryness—aqueous deficient versus evaporative, or perhaps mixed.
Related: Higher risk of dry eye disease linked to post-COVID-19 patients
The goal of treatment in aqueous-deficient DED is to improve tear volume, whereas the goal in evaporative DED is to improve the tear quality.
Both quality and quantity are important to have an adequate tear film. In aqueous-deficient DED, many treatments are aimed at increasing volume, such as punctal plugs and artificial tears, whereas others are aimed at decreasing inflammation.
Still other modalities are aimed at helping to protect, restore, and heal the ocular surface, such as scleral lenses and biological eye drops.
In evaporative DED, restoring normal evaporation can be accomplished through lid health and hygiene, such as warm compresses and artificial tears with lipid components. These treatments indirectly reduce inflammation and reduce signs and symptoms of dry eye.