Soft Contact Lenses in Dry Eye


Etty Bitton, OD, MSc, FAAO, FBCLA


Dry eye disease (DED)[1] is a complex inflammatory condition that continues to challenge patients, eyecare practitioners and manufacturers alike. This became even more evident during the COVID pandemic with an increase in digital device use (resulting in less blinking) and mask-associated dry eye (M.A.D.E).[2] Contact lenses in the dry eye arena can be a friend and a foe. To start with the latter: symptoms of dryness and discomfort continue to be one of the main issues leading to contact lens dropouts.[3-4] Luckily, improvements in polymer technology and innovations in manufacturing continue to bring new contact lens options to market to address vision and ocular surface-related challenges such as dry eye. At the same time, contact lenses can be a friend to those with mild-to-severe dry eye symptoms therapeutic or bandage contact lenses are used to manage ocular discomfort, to support the cornea during healing after surgery or when the cornea is being treated for an underlying disease state, or to protect the cornea from the environment or from mechanical interaction with the lids. In addition, soft lenses can be ‘a friend’ in managing allergies, drug delivery to the ocular surface and UV protection.

A Fraction Too Much Friction

But first, let’s address the (dis-)comfort. To increase the wettability of contact lenses, surfactants or humectants such as polyvinyl alcohol (PVA) and hydroxypropyl methylcellulose (HPMC) can be added to blister pack solutions.[5] The purpose of these polymeric additives is to lubricate the surface of the contact lens to retain moisture or to prevent it from sticking. [6-8] During the interblink interval, a contact lens is exposed to environmental factors that promote the migration of hydrophobic groups toward the surface. Internal wetting agents can also be added to the contact lens matrix itself. These agents can be released throughout the day to improve comfortable wearing time.[9-12] Both of these strategies – wetting agents in the blister pack or in the lens matrix - are geared to address surface friction. Reducing lens surface friction, which has been found to be one of the main drivers of contact lens discomfort, [13-15] can improve on-eye wettability of the lens. These advances in polymer technology and manufacturing of soft lenses can provide additional options, especially for mild-to-moderate dry eye patients.

Controlled Delivery & Allergy Management

Soft contact lenses are well established for their ability to correct vision however, they are increasingly being considered as an emerging drug delivery tool.[16-20] Contact lenses can offer a sustained and controlled drug delivery, which can offer several advantages in the management of ocular pathologies such as infections, inflammation, glaucoma, allergies and dry eye.[20] Dry eye and allergies often cause similar symptoms of ocular discomfort, hyperemia, tearing and inability to wear contact lenses comfortably due to disturbances to the ocular surface. Eyecare practitioners have the challenge of differentiating between the two conditions, which may present concurrently. Topical antihistamines are effective, but they typically contain preservatives that can further disturb the tear film. It has been shown that modern daily disposable contact lenses, with enhanced lubricating agents, act as a barrier to airborne allergens and can assist with alleviating symptoms (burning and stinging) and with reducing hyperemia and corneal staining.[21] In that way, contact lenses are indeed a friend. To help maintain contact lens wear during allergy season, a slow-releasing ketotifen (antihistamine and mast cell stabilizer) lens is now available in some markets.[22-23] Each lens contains 0.019mg of ketotifen without any preservatives to provide up to 12 hours of comfort, allowing some patients to continue to wear their lenses during allergy season.

Blinded by the Light

Dry eye patients often complain of sensitivity to light as one of their main symptoms. [24-25] Many use sunglasses to alleviate this, especially for outdoor activities however, this requires the burden of always carrying them. For those dry eye patients who can maintain contact lens wear, a recent breakthrough in soft contact lens technology resulted in a light-adapting lens.[26] This 2-week replacement daily wear lens filters light in the visible (55% of blue light, 380-460nm) and invisible (99-100% of ultraviolet, <380nm) spectrum, allowing patients to alleviate light sensitivity issues during indoor (ie, digital device use) and outdoor (tennis, golf, hiking, etc) activities.

"Keeping abreast of these advances can differentiate our practices
and ultimately benefit our patients”​

Innovation Universally

Innovation in contact lens technology continues to evolve in the hopes of addressing numerous contact lens-related challenges faced by patients, including dry eye, all around the globe. International associations and specially devoted international groups are on top of the topic. Keeping abreast of these advances can differentiate our practices and ultimately benefit our patients. In addition, we should realize that soft lenses can be a good friend in contact lens practice, including for bandage contact lenses applications (as described in the CLEAR report),[27] managing allergies, drug delivery to the ocular surface and UV-protection. As an eyecare practitioner, it is an exciting time to manage patients, as we have additional tools in our armamentarium to address dry eye issues in contact lens practice.

1. Craig JP, Nelson JD, Azar DT, et al. TFOS DEWS II Report Executive Summary. Ocul Surf. 2017 Oct15(4):802-812
2. Krolo I, Blazeka M, Merdzo I, Vrtar I, Sabol I, Petric-Vickovic I. Mask-Associated Dry Eye During COVID-19 Pandemic-How Face Masks Contribute to Dry Eye Disease Symptoms. Med Arch. 202175(2):144-148
3. Dumbleton K, Caffery B, Dogru M et al. The TFOS International Workshop on contact lens discomfort: report of the subcommittee on epidemiology. IOVS 201354:TFOS 20-36
4. Dumbleton K, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens. 2013 Jan 39:93-99.
5. Sindt CW. What’s in your blister pack? Review of Cornea & Contact Lens 2010 June.
6. Pence N. Thinking Inside the blister. Contact Lens Spectrum 2009 May
7. Menzies KL, Rogers R, Jones L. In vitro contact angle analysis and physical properties of blister pack solutions of daily disposable contact lenses. Eye Contact Lens. 2010 Jan36(1):10-8
8. Wygladacz K, Hook D, Steffen R, Reindel W. Breaking the cycle of discomfort. Contact Lens Spectrum 2014 October.
9. Dixon P, Chauhan A. Effect of the surface layer on drug release from delefilcon-A (Dailies Total1®) contact lenses. Int J Pharm. 2017529(1-2):89-101
10. Ousler GW 3rd, Anderson RT, Osborn KE. The effect of senofilcon A contact lenses compared to habitual contact lenses on ocular discomfort during exposure to a controlled adverse environment. Curr Med Res Opin. 200824(2):335-341
11. Bishop MJ, Sun CK, Coles-Brennan C, Gallois-Bernos A. Evaluation of daily disposable senofilcon A contact lenses in a symptomatic population [published online ahead of print, 2022 Jan 28]. Cont Lens Anterior Eye. 2022101574
12. Reindel W, Mosehauer G, Rah M, Proskin H, Steffen R. Clinical Performance of Samfilcon A, a Unique Silicone Hydrogel Lens, on a 7-Day Extended Wear Basis. Clin Ophthalmol. 202014:3457-3464
13. Nichols JJ, Willcox MD, Bron AJ, et al. The TFOS International Workshop on Contact Lens Discomfort: executive summary. IOVS. 201354(11):TFOS7-13
14. Coles MC, Brennan NA. Coefficient of friction and soft contact lens comfort. Optom Vis Sci 201289:e-abstract #125603
15. Roba, M., Duncan, E.G., Hill, G.A. et al. Friction Measurements on Contact Lenses in Their Operating Environment. Tribol Lett 201144 :387
16. Rykowska I, Nowak I, Nowak R. Soft Contact Lenses as Drug Delivery Systems: A Review. Molecules. 202126(18):5577
17. Chaudhari P, Ghate VM, Lewis SA. Next-generation contact lenses: Towards bioresponsive drug delivery and smart technologies in ocular therapeutics. Eur J Pharm Biopharm. 2021161:80-99
18. Gote V, Sikder S, Sicotte J, Pal D. Ocular Drug Delivery: Present Innovations and Future Challenges. J Pharmacol Exp Ther. 2019370(3):602-624
19. Xu J, Xue Y, Hu G, et al. A comprehensive review on contact lens for ophthalmic drug delivery. J Control Release. 2018 281:97-118
20. Franco P, De Marco I. Contact Lenses as Ophthalmic Drug Delivery Systems: A Review. Polymers (Basel). 202113(7):1102
21. Wolffson JS, Emberlin JC. Role of contact lenses in relieving ocular allergy. CLAE 201134:169-172
22. Pall B, Gomes P, Yi F, Torkildsen G. Management of ocular allergy itch with an antihistamine-releasing contact lens. Cornea. 201938(6):713-717
24. Kobia-Acquah E, Ankamah-Lomotey S, Owusu E, et al. Prevalence and associated risk factors of symptomatic dry eye in Ghana: A cross-sectional population-based study. CLAE 2021 Dec44(6):101404
25. Sherry A, Aridi M, Ghach W. Prevalence and risk factors of symptomatic dry eye disease in Lebanon. CLAE 2020 Aug43(4):355-358
27. Jacobs DS, Carrasquillo KG, Cottrell PD, et al. CLEAR - Medical use of contact lenses. Cont Lens Anterior Eye. 202144(2):289-329. doi:10.1016/j.clae.2021.02.002