Is the dry eye contact lens wearer at risk? Not usually

Individuals with dry eye symptoms cannot be excluded categorically from contact lens (CL) wear. Most patients with dry eye symptoms have a chronic disorder determined by genetics, age-related changes, or anatomic problems that interfere with blinking or the tear film. Furthermore, their symptoms may be exacerbated by drug use, environmental conditions, or the work they do. Although so-called "marginally" dry eyes usually provoke bothersome symptoms, they pose no real danger to ocular health, seldom require medical care, and are not an absolute contraindication to lens wear. Nevertheless, clinicians should conduct the appropriate tests to identify dry eye patients in the prefitting evaluation, so that potential problems in lens wear can be anticipated and addressed. The value of such testing cannot be overstated, as it is often possible to treat the underlying problem and thereby greatly minimize or even eliminate symptoms. This is particularly so when there is a drug, lens, or environmental component to the condition. Helpful approaches in CL wearers include blinking exercises, the use of wetting drops, or a modification of lens parameters (e.g., increased water content, larger diameter, and better edge design). Matching would-be lens wearers to the appropriate CL system is, of course, paramount.