Contact Lens Induced Dry Eyes (CLIDE)

CONTACT LENS
INDUCED DRY
EYES (CLIDE)
PRESENTED BY - SHRUTI DAGAR
B.OPTOM ( 4TH YEAR)
AMITY UNIVERSITY

Probably the most common complaint optometrists hear
from contact lens wearers is, "My contacts make my
eyes feel dry."

DRY EYE
 According to an article Published on February 28, 2019
by The Hindu by LV Prasad Eye Institute (LVPEI).
 By the year 2030, a staggering 275 million people are
expected to be affected by this problem.
 The projection is based on the current incidence rates of
45 per cent of the urban population.
 The authors said even rural India is likely to see 17
million new patients every year.

 The condition of discomfort to the eyes due to dryness has
been given many names: dry eye syndrome, ocular surface
disease and dysfunctional tear syndrome, among others. It
is generally accepted that there is an inflammatory component
to a dry eye disorder, which indicates that your body is
responding (or failing to respond) to the irritants and distresses
of daily life (e.g. pollution, allergens, dust, etc).
 Many individuals have little to no trouble with their eyes or
vision until they attempt to wear contact lenses. Dry eye is
associated with contact lens discomfort and is believed to be
one of the foremost reasons that some people give up wearing
contact lenses. This phenomenon is known as contact lens
induced dry eye (CLIDE).

 Since dry eye of mild severity can have few objective
clinical signs in the presence of subjective symptoms, the
appearance of symptoms due to contact lens wear is said
to induce the dry eye. It could also be possible that some
of these patients have sub-clinical dry eye disease before
contact lens wear.
 It is well known that dry eye affects visual function. Several
reports in contact lens wearers showed the deterioration of
visual function is caused by the instability of the pre-lens
tear film.
 Many authors have reported increased tear evaporation in
contact lens wearers, but some controversy exists.
 Increased tear osmolality was reported as a core
mechanism of dry eye disease.

RISK FACTORS FOR CLADE
Deposition on the Contact Lens

MEIBOMIAN GLAND DROPOUT
Meibomian glands supply the lipid layer on the pre-lens
tear film, thus stabilizing it. Contact lens wearers have
more meibomian gland dropout compared with non–
contact lens wearers.

 High water content,
 Faster speed of tear film thinning on the contact
lens,
 Use of over-the-counter medicines,
 Increased tear osmolality
 Men are at a higher risk in their twenties or thirties,
while women are more vulnerable in their forties
and fifties.
 Other high-risk factors identified are urban
residence, socio-economic affluence and
professional work (including computer-based
vocations).

SIGNS AND SYMPTOMS OF CLADE
Patients with CLADE show various symptoms, including-
 Foreign body sensation
 Dryness
 Eye strain/ Asthenopia
 Blurred vision
 End-of-day discomfort and the symptoms are worse in
the evening/night than during the day.
 These symptoms are caused by the deterioration of the
ocular surface due to prolonged dryness or VDT work.
 Early tear film breakup due to dry eye causes irregular
astigmatism or increased higher-order aberration. These
changes of optical quality will result in the decreased
visual function in CLADE.

Classification of contact lens discomfort. This figure is reproduced with permission from the Association
for Research in Vision and Ophthalmology from the following source: Nichols JJ, Willcox MD, Bron AJ, et
al. The TFOS International Workshop on Contact Lens Discomfort: executive summary. Invest
Ophthalmol Vis Sci. 2013;54:TFOS7–TFOS13.
CONTACT LENS DISCOMFORT

MECHANISM OF CONTACT LENS
ASSOCIATED DRY EYE DISEASE
 A healthy tear film comprises an outermost lipid layer
and an aqueous layer atop the epithelium (A).
 When a contact lens is inserted, the tear film is
separated into pre- and post-lens tear film. This causes
the thinning of the tear film and an increase in friction
between the contact lens and the ocular surface (B).
 When CLADE occurs, short BUT in the pre-lens tear
film, lid wiper staining, and keratoconjuntival vital
staining are observed as a consequence of tear film
deterioration and increased friction (C).
 Treatment of CLADE is done according to the TFOT
concept (D).

DIAGNOSING DRY EYE
 Accurate diagnosis of dry eye disease begins with a case history.
The prudent practitioner will ask about general symptoms of ocular
discomfort. The answers are not likely to lock them into a particular
diagnosis, but serve the purpose of determining that there is
discomfort that needs relief.
 Begin by asking whether your patient is experiencing any
burning, stinging, itching or dryness.
 Next, determine whether you are dealing with an acute or
chronic condition by establishing a timeline of the symptoms.
 Find out when the symptoms occur
 Take time to compile a detailed contact lens history
 Use both fluorescein and lissamine green to evaluate the
cornea, conjunctiva and tear film
 Evaluation of the upper palpebral conjunctiva (staining with
lissamine green).

TEAR FILM–ORIENTED DIAGNOSIS OF
CLADE
 To treat dry eye disease, proper diagnosis is essential. In Japan,
the tear film-oriented diagnosis (TFOD) concept has been
proposed by the Japanese Dry Eye Society. Under this concept,
each layer of tear film is assessed first. Subsequently, treatment is
initiated according to the abnormality of each tear film layer (tear
film-oriented therapy [TFOT]).
 To evaluate the lipid layer, lipid interferometry is a useful tool. DR-
1 provides information regarding kinetic movement of the tear film
lipid layer, including the central cornea. An important parameter
derived from lipid interferometry is noninvasive tear-film breakup
time (NIBUT), which measures pre-lens tear film stability.

 To evaluate the aqueous layer, the Shirmer I test is
useful to evaluate tear secretion on a certain stimulus.
Tear meniscus analysis using anterior segment optical
coherence tomography (OCT) emerged as a
noninvasive method to assess tear volume. Another new
methodology is strip meniscometry, which can measure
retained tear volume at the tear meniscus in only 5
seconds.
 To assess the tear film mucin layer, a new diagnostic
method based on the fluorescein breakup pattern can
be used for subjects without contact lenses. However,
this method cannot be used for subjects wearing contact
lenses. Further studies should be done in this field.
 To evaluate the corneal or conjunctival epithelium, vital
staining including fluorescein staining or Rose Bengal
(lissamine green) staining can detect abnormal
epithelium.

Ocular surface
manifestations in
CLADE.
In RGP contact lens
wearers, 3 and 9
o'clock staining is
well known (A).
In soft contact lens
wearers, smile mark
staining is observed,
but not often (B).
Frequent
manifestations are
edge staining and
LWE (B).
Typical slit-lamp
photographs of LWE
and edge staining
are shown
in C and D,
respectively.

MANAGEMENT OF CLIDE
 Management can be a creative concoction,
depending on the individual presentation. Here are
some of the most useful treatments and
recommendations in our arsenal:
 Supplements and Nutrition.
 Hygiene.
 Lubrication.
 Hyperosmotic.
 Antibiotics.
 Wear Schedule.

 Replacement Schedule.
 Lens Material
 Care Systems.
 Oral Antihistamines.
 Topical Antihistamines
 Topical Anti-Inflammatories

SOFT CONTACT LENSES
 Several manufacturers have developed contact lenses specifically
designed to reduce dry eye discomfort during lens wear. Popular
brands of soft contact lenses for dry eyes include:
 Bausch + Lomb Ultra. These silicone hydrogel contact
lenses feature Moisture Seal technology that provides unsurpassed
comfort and vision all day compared with the leading silicone
hydrogel lenses, according to the company. Moisture Seal
technology enables Bausch + Lomb Ultra lenses to retain moisture
for up to 16 hours, the company says.
 Dailies Total 1. Manufactured by Alcon, these single-use
daily disposable contact lenses feature an innovative water gradient
design: The water content is approximately 33 percent at the core of
the lens and increases to greater than 80 percent at the front and
back surface. Because of this unique design, Dailies Total 1 lenses
provide "a silky-smooth surface for comfort that lasts until the end of
the day," according to the company.

 Cooper Vision Proclear. These popular contact lenses for
dry eyes are made of a high-water hydrogel material and
contain molecules found naturally in human cell membranes
that attract and surround themselves with water, keeping
Proclear lenses moist and comfortable after 12 hours of wear,
according to Cooper Vision. Proclear contact lenses currently
are the only brand approved by the U.S. FDA to carry this
label: "May provide improved comfort for contact lens wearers
who experience mild discomfort or symptoms relating to
dryness during lens wear." Proclear lenses are available in a
variety of designs, including a daily disposable lens (Proclear
1 day), bifocal contact lenses and toric contact lenses for
astigmatism.
 Extreme H2O. Marketed by X-Cel Specialty Contacts,
Extreme H2O is another brand of soft lenses that many eye
doctors prescribe to reduce contact lens-related dry eye
problems. These high-water hydrogel lenses have unique
water-binding properties that allow Extreme H2O lenses to
retain virtually all their water content throughout the day,
according to the company. Extreme H2O lenses are available
in weekly and two-week disposable designs, including toric
designs for astigmatism.

SCLERAL LENSES FOR DRY EYES
 Another option for people with dry eyes is scleral
contact lenses. These large-diameter rigid gas
permeable (GP) lenses vault over the entire corneal
surface to help keep the front surface of the eye
from drying out.
 Scleral lenses also are custom-made to fit even
irregular corneas and often provide sharper vision
than soft contact lenses.
 Brands of scleral contact lenses include Valley
Contax, RoseK, PRose, Europa Sclerals, Purecon
etc.

ORTHOKERATOLOGY
 Here's a slightly different approach to contact
lenses for dry eyes: Wear contacts only when you
are asleep!
 Orthokeratology (or ortho-k) is a contact lens fitting
technique where specially designed gas permeable
contact lenses are prescribed for overnight wear
only. While you are asleep, the ortho-k lenses
reshape the front surface of your eyes (cornea) and
correct nearsightedness and other refractive
errors so you can see clearly during the day without
glasses or contact lenses.
 By eliminating your need to wear contact lenses
during the day, ortho-k may reduce contact lens-
related dry eye symptoms.

BIBLIOGRAPHY
 https://www.reviewofcontactlenses.com/article/how-
to-address-clide
 https://www.allaboutvision.com/contacts/lenses-dry-
eyes.htm
 https://iovs.arvojournals.org/article.aspx?articleid=2
717219
 https://www.aoa.org/Documents/optometric-
staff/Articles/Treating%20Dry%20Eye%20Symptom
s%20in%20Contact%20Lens%20Patients%20-
%20friedman%20edits.pdf

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