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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.
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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.
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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.
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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.
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