Management after Lens Refitting
The patient returned one month later for follow-up, reporting few changes in symptoms or contact lens wear time. I considered this an indication for advancing his treatment regimen to include therapies that increase tear retention.
While the patient continued with the lubricant therapies, I put in punctal plugs in both eyes and, later, added an eye mask for him to sleep in at night to help the eyes remain closed and moist. By the time he returned again, he had noticed a significant improvement in both symptoms and contact lens wear time. Fluorescein examination found less inferior punctuate corneal staining in both eyes.
Over the next few months, the patient reduced his artificial tear use and eventually was using only LACRISERT® (hydroxypropyl cellulose ophthalmic insert) in the morning for lubrication and an ointment at night to protect against lagophthalmos. He was regularly getting more than 8 hours of comfortable wear from his contact lenses, something he had not experienced in the previous 3 years.