Can contact lenses cure dry eye disease?

You may know that contact lenses are often blamed for CAUSING eye dryness, but is it possible for them to be the CURE? In today’s blog you’ll learn about some ways contacts are used to lessen dry eye symptoms.

Dryness of the eyes is an extremely common complaint among patients who wear soft contact lenses. Contact lens wear is also a risk factor for dry eye disease. Like many Optometrists, I watch carefully for what Tear Film & Ocular Surface Society (TFOS) says about dry eye, and in 2013 they published an entire report on contact lens discomfort, officially linking the two.


Dryness in contact lenses is well documented. It can manifest as eyes that feel tired, or feeling your lenses throughout the day. And contact lens companies are continually striving to improve their lens designs and materials to reduce dryness as much as possible.


DESPITE contact lenses being the culprit in so many scenarios, it can be hard to believe that they might actually be used to help dry eye disease, but that is EXACTLY the case in several different ways. So let’s go through some ways doctors use contact lenses to help your dry eyes get better!


How contact lenses assist Doctors in healing your eyes


Protection. Corneal protection is needed in the case of several conditions, including: entropion, trichiasis, tarsal scars, recurrent corneal erosion, post-surgical ptosis and surgical sutures or exposed suture knots.


Pain relief. The mitigation of corneal pain is another important indication for therapeutic contact lenses. The conditions most in need of this therapy include bullous keratopathy; epithelial erosion and abrasion; filamentary keratitis; and postoperative penetrating keratoplasty.


Healing. The use of bandage contact lenses to facilitate healing is particularly necessary for the following conditions: chronic epithelial defects, corneal ulcer, neurotrophic keratitis, chemical burns and basement membrane disease.


A bandage contact lens is designed to protect an injured, dry, or diseased cornea from the mechanical rubbing of the blinking eyelids. These lenses have no focusing power, and are not meant to improve your vision. They are purely to improve pain and allow the eye to heal. As the patient, you’re not expected to handle these lenses at all.


Use with Autologous Serum. One study by Shrader et al in 2006 tested the use of serum eye drops with hydrogel bandage contact lenses for the treatment of persistent epithelial defects(PED) like you might see in several diseases including dry eye disease. In this study, the cause of the persistent defect in the cornea were neurotrophic keratopathy or sterile corneal ulcer from RA. So, very sick eyes. The persistent epithelial defects healed in five of six eyes after a treatment period of 14 days. In one eye the PED became smaller, but it took 90 days until the lesion healed completely.


Use with Amniotic Membranes. There are several different types of amniotic membranes. Some have their own ring which acts as a scaffolding to hold the membrane in place. The prokera Slim that I talked about in this video above is an example of that type of membrane.


Another type of amniotic membrane is a dehydrated variety like the ones I use in my clinic. For these membranes, you must have a carrier to hold the membrane in place. For this, we use a bandage contact lens to allow the amniotic membrane to be in contact with the eye and disintegrate over a period of time.


Use in Recurrent Corneal Erosion (RCE). Recurrent erosions are a typical sequelae of epithelial basement membrane (basal lamina) trauma or are secondary to anterior basement membrane dystrophy, anterior basement membrane degeneration or stromal dystrophy.


A bandage contact lens is the second line of treatment, after hyperosmotic drops and/or ointment fail. RCE is common in dry eye disease patients and certainly worsens with dry eyes but bandage lenses can help a great deal.


Use in Filamentary Keratitis. Filamentary keratitis is a condition in which strands (“filaments”) composed of degenerated epithelial cells and mucus develop on and adhere to the corneal surface causing pain and foreign body sensation. Bandage lenses are helpful in treating this condition as well.


All about therapeutic bandage and drug eluting contact lenses


Therapeutic bandage lenses promote healing, relieve corneal pain and protect the ocular surface. It’s not so much an elective contact lens, and more of a medical procedure that is necessary to heal the eye.


Sclerals are unique contact lenses that work a little differently than traditional soft lenses. These lenses are made of breathable material and instead of resting on the cornea itself, they rest on the sclera of the eye.


This allows for a “bowl” of saline or artificial tears that becomes trapped between the lens and the cornea and in dry eye disease ensures constant hydration of the eye while not irritating the cornea like other lenses do. In fact, they protect the cornea from further irritation or damage. Patients can continue to use eye drops and artificial tears during lens wear, so your daily dry eye routine would not be interrupted.


Patients with dry eye disease struggle with pain, discomfort, eye exhaustion, confidence issues due to severe eye redness, and more. Scleral lenses do three things at once for these patients: they provide vision correction, they protect the eye, and they serve a therapeutic purpose by lubricating the eye. These factors can improve the quality of life of people with dry eye disease. They decrease pain and/or discomfort, eye redness, the need to repeatedly scratch the eyes or apply eye drops, and simultaneously provide crisp, clear vision during wear.


Research shows drug eluting contact lenses can increase the bioavailability of the drug by up to 50%, which eventually reduces the dose, dosing frequency, systemic drug absorption and associated side effects.1 Drug-eluting contact lenses, which gradually release drugs into the eye, offer a promising alternative to daily eye drops, which can be unpleasant and hard for patients to properly administer. In a 2016 pre-clinical study of glaucoma, the engineered lenses lowered eye pressure at least as well as daily eye drops. Recently, Johnson & Johnson launched the Acuvue Theravision with Ketotifen for the treatment of allergies.


I hope you enjoyed this video and it helped you see the other side of contact lenses and how doctors can actually use them to HELP your dry eyes, even if they were part of the cause of your dry eyes in the first place!



Sources:

https://answers.childrenshospital.org/drug-eluting-contact-lenses/

https://www.reviewofoptometry.com/article/the-compromised-cornea-take-cover

https://www.ouh.nhs.uk/patient-guide/leaflets/files/11034Pbandage.pdf

https://link.springer.com/article/10.1007/s00417-006-0257-y

https://www.tandfonline.com/doi/abs/10.1080/02713683.2018.1563702

https://journals.lww.com/apjoo/Fulltext/2020/12000/Contact_Lens_Wear_and_Dry_Eye__Beyond_the_Known.4.aspx

https://www.mdpi.com/1420-3049/26/9/2485

https://journals.lww.com/claojournal/Abstract/2022/03000/Contact_Lenses_for_Ocular_Surface_Disease.5.aspx?context=LatestArticles

https://journals.lww.com/claojournal/Abstract/2018/11000/Scleral_Lenses_in_the_Management_of_Corneal.4.aspx

https://www.reviewofcontactlenses.com/article/the-case-for-bandage-soft-contact-lenses

https://eyewiki.aao.org/Filamentary_Keratitis