Can You Keep Wearing Contact Lenses With Dry Eye?

A large number of people stop wearing contact lenses each year, and the reason is almost never the prescription. It is comfort.

The pattern is consistent. Lenses that were fine for years become tolerable for eight hours, then six, then four. Afternoons become uncomfortable, evenings impossible. Eventually the lenses stay in the drawer and the glasses come back out, and most people never mention any of it to their optometrist because it feels like something that just happens.

It is worth knowing that the underlying cause is usually identifiable and frequently treatable.

Why lenses and dry eye interact badly

A contact lens sits inside your tear film, dividing it into a thin layer in front of the lens and another behind it.

Both layers are thinner and less stable than the intact film would be. The lens material itself draws water, and the front surface is exposed and evaporates faster. So a tear film that is already marginal becomes clearly inadequate the moment a lens goes in.

This is why lens discomfort is so often the first sign of a developing dry eye problem rather than a lens problem. The lens has not changed. The tear film supporting it has.

Long term lens wear also appears to contribute to gland dysfunction over time, which makes the relationship circular. The lenses become uncomfortable because the glands are struggling, and the wear itself adds to the strain.

Blaming the wrong thing

Most people work through the same sequence, and it rarely helps.

They switch brands, sometimes several times. They move to daily disposables, which does help in many cases but not if the underlying tear film is the issue. They add lubricating drops, which buy twenty minutes at a time. They reduce wearing time, then reduce it again.

Each of those addresses the symptom. None of them addresses why the tear film stopped supporting the lens, which is why the improvement is usually partial and temporary.

What is generally going on

In the majority of cases the meibomian glands in the eyelids have become obstructed, so the oil layer that prevents tear evaporation has thinned. The tear film breaks up within seconds of a blink instead of lasting until the next one, and a lens sitting in that film has nothing to float on.

Less often, tear volume itself is inadequate, which is a different problem requiring different management.

Occasionally there is a contributing factor that has nothing to do with either, such as an allergic response to a solution preservative, or a lid margin inflammation that needs treating in its own right.

These are distinguishable, but not by trial and error with lens brands.

What can be done

The order matters here, and it is the opposite of what most people try.

Treat the tear film first. If the glands are obstructed, clearing them properly changes the surface the lens sits on, and lens comfort frequently improves substantially without changing anything about the lens itself. That treatment involves sustained heat at a therapeutic temperature, expression of the glands, and attention to the lid margin, none of which is replicable at home with a facecloth.

Then reconsider the lens. Once the surface is healthier, material, replacement schedule and fitting can be optimised sensibly. Daily disposables remove the solution and storage variables entirely and are often the right answer, but they work far better on a tear film that has been dealt with first.

Then review the environment. Air conditioned offices, long screen sessions and low blink rates all shorten comfortable wearing time, and small changes to screen height and blink habits make a measurable difference.

Two things worth ruling out

If discomfort came on relatively suddenly, it is worth checking for a solution sensitivity, particularly if you changed products around the same time.

If one eye is markedly worse than the other, or if there is redness, discharge or any pain rather than dryness, that is not simple dry eye and it should be looked at promptly rather than managed with drops. Pain and redness in a lens wearer always warrant same day assessment.

Where to from here

Giving up contact lenses because they have become uncomfortable is extremely common, and in most cases it is avoidable. The people who do give up are frequently the ones who never had the underlying tear film problem assessed, because nobody framed the discomfort as a treatable condition rather than an inevitability.

At Noranda Optometrist we assess the tear film and the glands before we assess the lens, because that order is usually what determines the outcome. If your lenses have become a four hour proposition, it is worth finding out why.

This article is general information and is not a substitute for an eye examination. If you have pain, redness or discharge while wearing contact lenses, seek assessment promptly.