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"I have been wearing contact lenses since I was sixteen, but lately they feel uncomfortable. I'm constantly taking them out and reinserting them." Why are my eyes so dry and irritated?
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If this was your complaint, then you may be suffering from CLIDE or Contact lens induced dry eyes, a very common eye condition that affects millions of contact lenses wearers across the world. About 22% of people wearing contact lens report dry eyes.* Many suffer reduced contact lens wearing time or even discontinue lens wear altogether as a result of discomfort due to dry eyes. Fortunately, this condition can be treated. There are various products designed to moisten or lubricate your eyes, but you should seek out medical advice.
* Buscemi, Philip M. Optometric Management. Jan 1999 |
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Fast facts to know why do we get dry eyes? |
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The name "dry eye" can be a little confusing since one of the most common symptoms is excessive watering of the eyes! It makes more sense, though, when you learn that the eye makes two different types of tears. The firs type, called lubricating tears, is produced slowly and steadily throughout the day. Lubricating tears contain a precise balance of mucous, water, oil, nutrient proteins, and antibodies that nourish and protect the front surface of the eye.
The second type of tear, called a reflex tear, does not have much lubricating value. Reflex tears serve as a kind of emergency response to flood the eye when it is suddenly irritated or injured. Reflex tears might occur when you get something in your eye, when you're cutting onions, when you're around smoke, or when you accidentally scratch your eye. Another cause of reflex tearing is irritation of they eye from lack of lubricating tears. If your eye is not producing enough lubricating tears, you may have dry eye.
Hormonal changes dur to aging and menopause, thyroid problems and vitamin deficiencies can contribute to increasing dry eyes. Some diseases and conditions - like rheumatoid arthritis, menopause, lupus and Sjogren's Syndrome - also cause dry eye in many patients. |
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Understanding contact lens induced dry eyes |
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The two types of contact lenses most often used today are soft lenses and rigid gas permeable (RGP) lenses. The softness in a contact lens comes from the amount of water that the lenses contain, and they feel pliable rather than hard. Because they provide more oxygen to the eye, people usually find them comfortable right away. RGP lenses are hard lenses that let in at least as much as oxygen as do soft lenses.
A contact lens placed on the eye does not merely rest on top of the tear film but is immersed within it. The cornea, which usually receives direct oxygen from the atmosphere now gets only diffused airing. Correct design and fitting of the lenses are essential for comfort, safety, and accurate correction. Improvements in contact lenses have made them more comfortable and easier to wear.
People suffering from CLIDE usually have adequate tear quantity and quality under normal condition, however when the eye is stressed - in this case, by the introduction of contact lens, may experience a symptomatic dry eye state. It is also believed that constant rubbing and movement of the contact lens across the surface of the cornea may result in a less stable tear film and contact lens induced dry eye symptoms.
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A RGP lens especially reduces blink rate leading to enhancing evaporation and leading to dry eyes. Contact lens induced dry eye also occurs in some people who may have had a marginally dry eye before they were fit with contact lenses or may actually be the result of contact lens wear. |
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Will dry eye affect my eye sight? |
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Dry eye on its own should have no effect on your vision, it does not cause permanent sight loss. There may be some temporary blurring of vision but this is normally relieved by blinking.
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What are the symptoms of dry eyes?
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If you wear contact lenses, you may find they become uncomfortable. Both eyes are usually affected. Symptoms include:
• Irritation in the eyes.
• The eyes may feel sandy or gritty.
• Foreign body sensation, burning, and/or itching.
• Slight blurring of vision from time to time.
• Light sensitivity or even.
• Excessive tearing.
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What makes dry eyes worse? |
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Symptoms tend to increase from morning to evening; i.e., the longer a person wears the lenses throughout the day, the more likely he or she is to have dry eyes complaints. Dry eyes can also be made worse by: windy weather, which dries out the eyes further; tobacco smoke; low humidity; air-conditioning or when you blink less often. Medications such as anti-histamines, anti-depressants, sleeping pills, diuretics or beta-blockers decrease tear production and may aggravate symptoms. |
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"Patients with dry eyes may complain of anything from irritation, itching, and burning to blurred vision and even excessive tearing."
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How are dry eyes diagnosed?
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If you suspect you have dry eyes on wearing contact lenses, you should make an appointment to see your eye doctor. Your historical information often gives the most reliable clues to the diagnosis of dry eyes. A careful examination of all the eye tissues usually provides more documentation for making a diagnosis.
While assessing for CLIDE your doctor will document your comprehensive contact lens history. He will evaluate whether the lens has been worn daily or extended overnight. Your doctor may need to ensure that you are not sleeping in lenses approved for daily wear, as this can lead to CLIDE. Environment factor such as humidity, closer to heating or air conditioning duct may aggravate CLIDE.
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Your eyes may be examined using a special microscope called a slit lamp. The condition of the tear film (the layer of liquid) on your eyes is looked at, and the cornea (front of the eye) is checked to see if it has dried out, or has been damaged. Your doctor may also use different dyes to see if skin cells on the eye have worn away. The dye is put in your eye as an eye drop, and the dye will temporarily stain the eye where cells have worn away.
A test called the Schirmer test may also be carried out. A thin strip of filter paper is place just inside the lower eyelid. After a few minutes, the paper is then removed to see how much liquid it has soaked up. Your doctor can then measure how dry your eyes are. |
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What treatments are available to treat my symptoms?
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For those patients with mild to moderate dry eyes the first course of treatment may be to use unpreserved artificial tears or rewetting drops as prescribed by the doctor. Depending on the nature of your tear film deficiency, the doctor may have you use a specific type of artificial tear that has different characteristics in terms of salt content and viscosity.
In addition to artificial tears, your doctor may suggest the need to switch to a less irritating or preservative free lens care system. These are specially formulated lens lubricating and rewetting drops specially designed for contact lens wearers because other types of drops may contain ingredients that can damage the lens. Rewetting drops for contact lens wearers are usually not as thick as gels and are designed to provide relief and long-lasting lubrication to help retain moisture. Most doctors recommend preservative-free tears because they are the most smoothing and have fewer additives that could potentially irritate the eye. Avoid products that are irritating to the eyes - they don't have adequate lubricating qualities and often make the problem worse.
Protein removal is also an important issue, especially for patients with CLIDE. In heavily depositing persons with less frequently replaced lenses, regular enzyme treatments are advised. Daily wear lenses and daily disposables will be a good option. In severe cases, a reduced wearing schedule of daily- replaced lenses would be ideal. If optically viable, your doctor may consider changing your lens to a high water content lens that retains water in the lens matrix or an RGP lens with a low amount of silicone content.
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In addition, your doctor may counsel you on environmental factors and modifying the diet. Most likely you will be asked to drink plenty of water. |
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Living with it: what can I do to reduce my discomfort from dry eye? |
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1. Good hydration: drink plenty of water, reduce caffeine intake
2. Protect the eyes from harsh weather conditions like wind and dust
3. Environmental control (minimize impact of heat and air-conditioning by turning down, redirecting vents etc)
4. Avoid smoky environments or quitting smoking if you smoke
5. Identify and replace (if possible) medications which are causing or exacerbating dry eye
6. When watching TV, using the computer or other eye straining activities, take breaks
7. Make conscious effort to blink frequently - especially when reading
8. Eat healthy food containing eye nutrients especially with vitamin A, C and E
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