10 Strategies to
reduce the symptoms of dry eye
with contact lens wear

There are a few strategies that can be used to reduce the symptoms of dry eye particularly in people wearing contact lenses. We can concentrate on the environment, internal causes and the contact lenses themselves. 

Environment

It is important to improve your environmental conditions to reduce symptoms of dry eye. This would include avoiding air-conditioning or at least having air-conditioning vents aimed away from your face. This is particularly important when driving to ensure that the air vent is aimed towards your body rather than your eyes. It is useful to try to improve the humidity or water content in the room which can be done by having pot plants in the room or alternatively having a shallow bowl of water containing florist's foam. Florist's foam are the green blocks that you find flower stems inserted into in a floral arrangement. This will increase the humidity content in the air and help avoid your eyes drying. Also try to avoid dusty environments as the dust will increase the risk of your eyes drying.

When doing computer work please ensure that you glance up frequently as this will automatically make you blink and lubricate your eyes. Some people find it useful to have a break for five minutes every half an hour or so.  You can also do blinking exercises and sometimes just close and squeeze your eyes shut for several seconds.

Lubricants

Ocular lubricants are a mainstay of dry eye treatment, however you must remember that eyedrops will treat the symptoms and not the underlying cause of dry eye. A thick or viscous drop or gel may be useful for night time use. A commonly used night-time lubricant gel is called Genteal gel and is suitable for use with contact lenses. Some people find a gel is too viscous and smears their vision if used during the day and so they prefer using an eye drop. Commonly used daytime drops would be either Hylofresh or Refresh capsules. Both of these drops are preservative-free and suitable for use with contact lenses. It has been found that long-term use of preserved eyedrops can cause irritation to the ocular surface exacerbating dry eye, which is why where possible preservative-free drops are preferred. The length of time that eyedrops will maintain the lubrication of your eyes can be increased by applying Optrex Actimist spray to the closed eyelids five minutes after instilling the lubricating eyedrops. This places a thin lipid layer over the top surface of the tear film reducing evaporation, however Actimist spray is not generally suitable for use while contact lenses are being worn.  Alternatively Cationorm or Nova Tears eyedrops can be instilled which also reduce tear breakup time by replacing the lipid layer. They are not suitable while wearing contact lens.

Contact lenses

With the contact lenses themselves, it is important to maintain good cleanliness to reduce the symptoms of dry eye. When contact lenses are not maintained properly and become deposited with protein and mucous this creates a hydrophobic coating on the surface of the contact lens causing further ocular irritation. This can be alleviated by having daily replacement contact lenses prescribed, which means that the lenses are replaced each night and only worn once. For contact lenses that are removed and cleaned and worn for 2 to 4 weeks, it is important to clean them diligently and thoroughly each night according to instructions. An eyedrop that helps clean contact lenses while they are being worn is available and called Blink'n'Clean. It contains a mucolytic which helps dissolve mucous from the contact lens surface. Specific contact lens brands and materials are available and crucial in reducing the occurrence of dry eye. As well is having daily replacement contact lenses prescribed, it is important to have a material which has been specifically designed to maintain hydration and lubrication of the contact lens surface even towards the end of the day. There are several contact lenses available that reduce dry eye symptoms by maintaining their hydration and a more extensive article can be found here.

Quality of Tears

There are also techniques available to improve the quality and quantity of tears in the eye. Common strategies are lid scrubs and heat packs applied to the eye lids to improve tear gland function. A commercially available product called Blephex foam is available, and is best used whilst showering. A small portion of foam is applied to the fingertip and rubbed along the lid margin in both eyes. This is then rinsed off under the shower. The mechanical action of rubbing and the Blephex foam will reduce the bacterial load on the lid margin and help unblock tear glands. After this process a wheat or rice bag should be warmed up in the microwave and then applied to the closed eyelids for several minutes. This will soften any viscous oils in the meibomian glands and help any blocked glands discharge. This process can be further helped by massaging the glands, which is done by placing a finger at the bottom of the closed lids and rolling your finger upwards to express the glands.

Certain dietary intakes have also been found to improve dry eye. 2000 to 3000 mg daily of Omega-3 daily will help, however it takes two months for the improvement to be noticed. It is also important to maintain hydration and drink adequate fluids. 

Prescription ciclosporin eye drops such as Ikervis or Cequa have been found to improve meibomian gland secretions after several months of daily use. 

Intensive pulsed light therapy improves the symptoms of evaporative dry eye by stimulating the parasympathetic innervation of the meibomian glands. 

Blinking Exercises

For computer and contact lens users and those performing intensive reading tasks,  the 20/20/20 rule for episodes of rest from close focus becomes the 20/20/20/20 rule (every 20 minutes, look 20 ‘feet’ away for 20 seconds and perform 20 blinks which are full, complete, brief, quick, rapid, soft, light, relaxed, confident and natural looking.

In summary remember to:

• Avoid air-conditioning
• Use floral foam
• Blinking exercises
• Ocular lubricants
• Keep contact lenses clean
• Use Blink'n'Clean drops
• Increase omega-3 intake
• Lid Scrubs
• Hot packs 
• Massage eyelids

Hopefully by taking some of these strategies into account you should be able to reduce or resolve any symptoms of dry eye that you may have encountered while wearing contact lenses.