b. Dry eye secondary to incomplete blink
Yes. That no significant improvement was seen when contact lens wear was stopped suggests that the patient’s condition is of ocular rather than contact lens origin. Indeed, the corneal exposure secondary to incomplete blinking can cause thinning of the tear film and lead to dry eye symptoms and inferior punctate keratopathy.1
Microlagophthalmos may contribute further to the keratopathy through increased tear evaporation and ocular surface exposure at nighttime. While this patient was symptomatic during contact lens wear, his low tear volume, persistent exposure keratopathy, absence of other ocular surface diseases such as meibomian gland dysfunction (MGD), and, above all, lack of improvement following discontinuation of contact lens wear all point to incomplete blink and lid closure as the key basis of his symptoms of dry and irritated eyes.
- McMonnies CW. Incomplete blinking: exposure keratopathy, lid wiper epitheliopathy, dry eye, refractive surgery, and dry contact lenses. Cont Lens Ant Eye. 2007;30:37-51.