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Presentation

A 25-year-old white male patient reported dryness and irritation with contact lenses in both eyes. He had been wearing contact lenses for 8 years, and over the last 3+ years the lenses had become increasingly uncomfortable. At the time of his visit, he could not wear the lenses for more than 6 to 8 hours before discomfort set in, and his eyes felt dry and therefore uncomfortable for the rest of the wearing day. He had been prescribed a variety of artificial tears (which he used frequently), lubricating ointments, topical cyclosporine, even punctal plugs, but nothing sufficiently helped.

The patient had previously been noted to have a nocturnal lagophthalmos and a history of inferior corneal staining that did not resolve with periodic cessation of lens wear. His job required him to drive 3 to 4 hours every day.

Which of the following could have contributed to this patient’s symptoms of dry and irritated eyes?

○	a. Contact lens wear Yes. Symptoms of dryness and discomfort are prevalent among contact lens wearers and are among the most common causes of contact lens intolerance.¹ What else might have contributed to the patient’s symptoms? Please select again. Richdale K, Sinnott LT, Skadahl E, et al. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. 2007;26:168-74.
○	b. Long driving Yes. It is known that visually or intellectually demanding tasks are associated with reduced blink rate and, in some cases, incomplete blinking.^1,2 In this patient’s case, driving for long periods of time could result in less frequent or partial blinking and exposure of the ocular surface to evaporative forces, which could exacerbate dry eye symptoms and signs. What else might have contributed to the patient’s symptoms? Please select again. Wong KK, Wan WY, Kaye SB. Blinking and operating: cognition versus vision. Br J Ophthalmol. 2002;86(4):479. 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.
○	c. Lagophthalmos Yes. Proper eyelid closure and a normal blink pattern are essential to preventing excessive drying of the cornea and maintaining a stable tear film. Unable to fully close their eyelids, patients with lagophthalmos commonly complain of dry and irritated eyes. What else might have contributed to the patient’s symptoms? Please select again.
○	d. All of the above Yes, multiple factors in the patient’s history could cause or exacerbate his dryness problems. Contact lens wear can profoundly impact the tear film of susceptible patients, inducing symptoms of dryness or exacerbating preexisting dry eye. Driving, which requires intense visual concentration, can lead to reduced blinking, which may exacerbate dry eye symptoms and contribute to the inferior corneal staining. Alternatively, the inferior staining could be a manifestation of exposure keratopathy, which, along with symptoms of ocular dryness and irritation, could be attributable to lagophthalmos.

Jack L. Schaeffer, OD, FAAO, is president, CEO, and chief of optometry at Schaeffer Eye Center in Birmingham, AL. He is a consultant for Bausch + Lomb.

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Presentation

Which of the following could have contributed to this patient’s symptoms of dry and irritated eyes?

Eye Care Professionals Only