WHAT IS DRY EYE?
Dry eye affects many individuals. Symptoms include irritation, burning, light sensitivity, excessive tearing, and blurry or fluctuating vision.
Patients have dry eye for a variety of reasons including low-grade inflammation, systemic conditions, eyelids that do not close completely, lack of tear production, lack of oil production, as well as scarring or irregular corneas due to conditions such as Ocular Cicatricial Pemphigoid.
In Focus prides ourselves on completing a thorough examination of the eyes to determine the root cause of each patient's dry eye. We design custom treatment regimens for all of our patients, often alongside their ophthalmologist to provide them the best results.
Women, particularly those over 50 years of age, typically experience dry eye more often then men. Certain systemic conditions including some medications can also worsen dry eye. Constant near work, computer use and air quality may also impact dry eye.
Mild cases can be treated with a regimen of daily lid hygiene and the use of artificial tears. More moderate to severe cases may need customized treatment options including medication. Frequent follow ups are important to ensure improvement of the condition and overall eye health.
At our office, each dry eye patient leaves with a written treatment plan. Follows up schedule and treatment plans will vary depending on the dry eye patient's unique diagnoses.
WHAT KINDS OF CONTACT LENSES CAN I WEAR WITH DRY EYE?
Those with dry eye can wear contact lenses as long as treatment is started on the underlying cause of dryness. With all patients, we first take a comprehensive look at the eye and start a treatment of the dry eye. After seeing how each patient responds to treatment, recommendations for contact lenses can be made.
1.) Soft Contact Lenses
Each soft contact lens is made of a plastic material with different properties including thickness, oxygen permeability, how much the plastic attracts or repels water, how bendable or stiff the lens is, and how often you replace the lens.
It is important to work with a doctor who is knowledgeable in these factors when prescribing contact lenses for those with underlying dry eye. The type of material which may work for one person, may not work for another. Everybody is unique.
With very severe forms of dry eye, soft contact lenses may not be an option, but there are still options for you!
2.) Scleral Lenses
After traditional treatments have failed, scleral lenses can be an amazing management option for severe dry eye. Scleral lenses are a large-diameter rigid lens that is made of an oxygen-permeable plastic.
In between the lens and your eye is a reservoir of preservative-free sterile saline that stays in place all day. This provides constant lubrication to the eye.
In cases like Stevens-Johnson syndrome, Sjogren's Syndrome, or Exposure Keratopathy due to Bell's Palsy, where more than just the cornea is compromised, the lens can be made to be much larger to protect the conjunctiva (white portion of the eye) as well.
These lenses, in combination with excellent dry eye management can provide wonderful relief to patients who have been suffering from severe dry eye.
3.) Rigid Gas Permeable (RGP) & Hybrid Contact Lenses
Rigid gas permeable contact lenses (RGP) are made of a durable rigid, oxygen permeable plastic. They can come in many sizes but all are smaller than the iris (the colored portion of your eye), and they sit gently on a layer of tears that is in front of the cornea (the clear anterior surface of the eye).
Hybrid contact lenses are comprised of a rigid gas permeable lens in the center and a soft contact lens "skirt" surrounding the lens. This can aide in helping the lens center and making them more comfortable.
These lenses can be an option for those with dry eye because of the tears that are allowed to flow under the lenses.
AN ADVANCED WAY TO MANAGE DRY EYE
Scleral lenses are a unique way to manage dry eye that is getting increasingly popular as people respond well to the technology. As environments become drier and people have increasing amounts of computer work, we believe this type of lens will become more commonplace.
Scleral lenses are a large-diameter (15-22mm) lens that is made of a completely rigid (hard) oxygen-permeable material. They are filled with a tear solution before being placed on the eye. The tear solution sits on the eye all day, eventually exchanging with your own tears to remain under the lens and on top of the front of your eye. This provides a constant moisture source for patients with very dry eyes.
For some patients, including those with Sjogren's Syndrome, Exposure Keratopathy, Ocular Cicatricial Pemphigoid, and Graft-versus-Host disease, even with aggressive treatment, results are minimal because of the inflammatory damage to the eyes caused by the body. These patients are great candidates for scleral lenses.
PATIENT STORIES: DRY EYE & SCLERAL LENSES
This patient had dry eye that caused redness. Here they are wearing custom mold-designed scleral lenses. The first photo is wearing their new lens for the first time and the second photo is after a few months of scleral lens wear where the eye had a chance to heal from chronic dryness. You can see how white and quiet the eye is after wearing a scleral lens.
Our patient above had multiple surgeries to treat skin cancer on the lower eyelids. This caused eyelids that were unable to close completely, causing a dryness called exposure keratopathy. This caused fluctuating vision and blurry vision. We fit them with mold-designed scleral lenses which provided them great relief.
Before Scleral Lens:
Eye is dry and epithelial cells are rolling together to create "filaments" which dangle off the cornea and pull, creating pain and very poor vision. The picture to the right is the left eye where the filaments had fallen off, creating small corneal abrasions which had to be treated with antibiotics.
After Scleral Lenses:
The front surface of the cornea is smooth and clear. There are no filaments and no abrasions. Because of the smoothing of the surface, this patient no longer has light sensitivity.
This patient had a very severe form of dry eye called filamentary keratitis. They were unable to work, drive, or function prior to scleral lenses because their vision was so poor. They also experienced intense light sensitivity and pain. After lenses, they are able to drive, meet with friends, and are re-applying for their job as a teacher. They have 20/20 vision. We are so happy for them.