Dryness-Related Part 1: My Patient Has Dryness-Related
Symptoms. How to Manage?
Poor tear quality (e.g., tear break-up time < 10 seconds), inadequate tear volume (e.g., Zone-Quick ≤ 9mm; Schirmer < 10mm), medications (e.g., antihistamines, anticholenergics, tricyclic antidepressants, oral contraceptives), post-menopausal female, blepharitis, meibomian gland dysfunction (MGD).
Inferior decentration, high edge clearance, excessively thick edge and/or center thickness.
Resolve any lens issues initially (see “Design-/Fit-Related” below).
Concurrently, treat dry eye symptoms with basic therapy, usually including omega-3 supplements, hydration, warm compresses, and lubricating drops (e.g., Blink for Contacts, Systane Ultra, or any non-preserved artificial tear such as Refresh Optive Sensitive Preservative-Free) on a periodic and regular basis. If the lens is non-wetting, this may be enough to create most of the dry eye symptoms.
Once any lens wetting and fit issues are resolved, if basic treatment of dry eye symptoms are not resolved, consider punctal plugs or Restasis.
Look carefully for blepharitis and MGD and treat. Consider discontinuing contact lens wear for a week while treatment is started (if possible). Consider warm compresses and lid massage b.i.d.
Consider Blink for Contacts before, during, and after contact lens wear. Consider a one- to two-month course of Restasis b.i.d. In some cases, consider doxycycline oral 50 mg q.d. or Oracea p.o. q.d.
- Inferior decentration: Please see Spherical Lenses FAQ 5.
- High edge clearance: Reorder with steeper peripheral curve radius and/or narrower peripheral curve width.
- Edge thickness: Reorder with a lenticular (or similar) edge design (i.e., plus lenticular for high minus powers — typically ≥ -5D; minus lenticular for all plus and low minus — typically ≤ -1.50D powers).
GP Lens Institute
- Rinehart J. The Balancing Act.
GP Lens Institute Advisory Committee members: Bruce Anderson OD, Marlane Brown OD, Carmen Castellano OD, Walter Choate OD, S. Barry Eiden OD, John Laurent OD, PhD, Derek Louie, OD, MS, Joe Shovlin OD, Frank Weinstock MD, Bruce Williams OD.