Contact lenses in dry eye disease and associated ocular surface disorders

Abstract

Dry eye disease (DED) is prevalent in all age groups and is known to cause chronic ocular discomfort and pain, and greatly affects the quality of life. Patients with ocular surface disease (OSD) may also have reduced tear secretion due to lacrimal gland damage, thus leading to aqueous deficient DED. Even with conventional management modalities such as lubricating eyedrops, topical corticosteroids, autologous serum eyedrops, or punctal plugs, many patients continue to suffer from debilitating symptoms. Contact lenses are increasingly being used in OSD providing surface hydration, protection from environmental insults, mechanical damage from abnormal lids, and as a modality for constant drug delivery to the ocular surface. This review describes the role of soft lenses and rigid gas-permeable scleral lenses in the management of DED associated with OSD. The efficacy of contact lenses, lens selection, and optimal lens fit are reviewed for specific indications.

Keywords: Aqueous deficiency dry eye; Stevens–Johnson syndrome; bandage contact lens; contact lens; dry eye disease; graft-versus-host disease; ocular chemical burns; ocular surface disease; scleral lens.

Figure 1

Uses of a bandage contact lens: (a) Right eye of a patient with an acute alkali corneal burn at presentation with corneal and conjunctival epithelial defects. (b) After placement of a bandage contact lens (BCL) and medical management with topical medications, the complete resolution was noted after 5 days. (c) A poorly fitted BCL over keratoprosthesis in the immediate post-operative period shows folds on the BCL along with inferior displacement. (d) BCL placed over keratoprosthesis with a steep fit, showing an air bubble trapped between the BCL and the anterior surface of the cornea

Figure 2

Fitting of scleral lenses in patients with Stevens–Johnson syndrome (SJS) sequelae: (a) Left eye of a patient with SJS sequelae showing corneal vascularisation, stromal scarring in the inferonasal cornea, conjunctivalization inferiorly from 5 to 8 o’clock with a well-centered scleral lens, the two black dots on the lens suggests the left-sided laterality of the scleral lens for easy identification of the lens by the patient. (b) The right eye of a patient with SJS sequelae showing a scleral lens, and total limbal stem cell deficiency with corneal scarring was seen although significant visual improvement was not seen with scleral lenses, the patient’s photophobia was reduced and she was comfortable with the scleral lens. (c) Right eye of a patient with SJS sequelae fitted with a scleral lens post mucous membrane grafting in the upper and lower eyelids

Figure 3

Diffuse slit-lamp image of the right and left eye of a patient with Stevens–Johnson syndrome sequelae after 4 h of scleral lens wear showing (a) entrapped debris in the vault causing midday fogging (right eye) and (b) drying of the anterior lens surface with mucin deposits on the anterior lens surface (left eye)