A number of treatments are available when patients, especially contact lens wearers, are assessed at the onset of the disease

A number of treatments are available when patients, especially contact lens wearers, are assessed at the onset of the disease.
Dry eye disease (DED) affects approximately 1.5 billion people worldwide and is the most common ocular surface disease.1 But it is not necessarily debilitating, especially for contact lens-wearing patients.
Although more patients are wearing contact lenses, the condition remains somewhat underdiagnosed and the range of symptoms is essentially unlimited, as patients perceive the symptoms they are experiencing as normal and therefore do not report symptoms to their eyes. Health Physician Report.2
Redness, burning, and gritty sensations are common in people with DED, along with sensitivity to light, blurred vision, and water and/or mucus in the eye.

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These symptoms are usually most severe in people who wear contact lenses and can lead to persistent irritation, pain and reduced quality of life.
Characterized by a loss of homeostasis in the tear film of the eye, which some researchers describe as a “vicious cycle of corneal epithelial damage and inflammation”3, DED is exacerbated by the time many adults spend on screens.According to a 2018 Nielsen report, the average American adult’s screen time has increased to more than 11 hours a day.4
Additionally, the ongoing COVID-19 pandemic has left its mark on DED by complicating underlying illness in patients who frequently wear masks.Premature tear evaporation can occur when a person’s breath moves up to the eye during masking.
The pandemic has also led to more patients choosing to wear contact lenses because they fog up when they wear masks, which could add to the CDC’s current estimate that 45 million people in the U.S. wear contact lenses on a regular basis.5
Related: Q&A: The Pandemic’s Impact on the Number of Dry Eye Patients Consequently, these patients are also more prone to lens intolerance — another detrimental effect of DED.
Despite these troubling trends, today’s eye care practitioners have options for treating DED of varying severity when patients are properly evaluated at the onset of the disease.
The most common cause of dry eye in patients is Meibomian Gland Dysfunction (MGD), which is usually treated with eyelid margin hygiene, removal of Meibomian gland blockages, and reduction or elimination of inflammation.
In more severe forms, patients experience persistent, disabling discomfort with accompanying symptoms such as marked conjunctival staining, severe punctate erosions, filamentous keratitis, corneal ulcers, trichiasis, keratosis, and symblepharon.
DED is also a major cause of lens intolerance in contact lens wearers, with symptoms often including blurred vision, eye discomfort and irritation, eye fatigue, and a foreign body sensation in the eye.
To successfully prescribe contact lenses for patients with DED, physicians must be able to optimize the ocular surface to improve lens tolerance.Contact lenses as foreign bodies may exacerbate signs and symptoms if the ocular surface is damaged or the tear film is insufficient.
The goals should be to reduce inflammation, restore ocular surface stability and tear film homeostasis, and relieve any obstruction associated with MGD.
General treatment algorithms are available from TFOS, 7 Corneal Extracorporeal Disease and Refractive Society, 8 and the American Society for Cataract and Refractive Surgery9.Depending on the severity, the following modalities and products are also recommended for the care of DED and may be used collaboratively, depending on the patient’s response to treatment.Related: Q&A: Factors to Consider When Treating People With Dry Eye
Scleral lenses are also an effective treatment, especially when used as a combination therapy.The tear film reservoir is usually a preservative-free saline between the eye and the lens, which can be modified into a DED’s “cocktail” when mixed with fluid.This is a benefit not found with any other type of contact lens.
For regular contact lenses, Regene-Eyes are most effective when used about 10 minutes before and about 10 minutes after the lens is removed.
When steroids are prescribed for faster relief, Regene-Eyes is an effective transition due to its ability to lubricate the eye and reduce inflammation.Steroids work well for patients with mild to moderate dry eye, but severe cases require ways to provide longer-term benefits.
It is important to determine the basic conditions for drying – lack of water and evaporation, or possibly a combination.Related: Higher risk of dry eye associated with post-COVID-19 patients The goal of treatment for water-deficient DED is to improve tear volume, while the goal of evaporative DED is to improve tear quality.

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Both quality and quantity are important to have an adequate tear film.In dehydrated DED, many treatments aim to increase volume, such as punctal plugs and artificial tears, while others aim to reduce inflammation.There are other modalities designed to help protect, restore and heal the ocular surface, such as scleral lenses and biological eye drops.
In evaporative DED, normal evaporation can be restored by eyelid health and hygiene, such as heat compresses and artificial tears with lipid components.These treatments indirectly reduce inflammation and reduce the signs and symptoms of dry eye.