contact lens business
Keeping Dry Eyes in Contacts
Consider these less commonly used strategies to help make these patients comfortable.
By Christopher Kent, Senior Associate Editor

New medical treatments for dry eye are always a welcome development. But other approaches -- some traditional but overlooked, some practical rather than medical -- can also be helpful.

Because dry eye is a frequent cause of contact lens dropouts, we asked several M.D.s to share less commonly used strategies that can help keep dry eye patients comfortable in contact lenses.

Bruce Koffler, M.D., Lexington, Ky.:

► "Lacrisert pellets are an often-overlooked option for helping contact lens wearers suffering from dry eye. These slow-release hydroxy-propyl cellulose pellets are shaped like a cylinder, 4 to 5 mm in length. The patient places them in the inferior cul de sac where they melt over a 24-hour period. They ease symptoms of dry eye much like an artificial tear, and they're compatible with contact lenses. A pharmacist can obtain them by contacting Merck.

"Lacrisert pellets are comfortable in the eye, and work well for the moderate to fairly severe dry eye patient. Some patients may need to supplement the pellet with artificial tears during the day. If one pellet produces too much cellulose, blurring vision, half a pellet can be used instead. Some patients do better inserting a pellet at night before bed so the pellet melts by morning.

"We only treat about 5% of our moderate to severe patients with Lacrisert, but it can be a lifesaver when tears and gels don't suffice. It's a good alternative to try before resorting to punctal occlusion. We don't use Lacrisert as a first-line therapy because patients need insertion training, and because of the extra effort required to get it from the pharmacy."

Richard L. Lindstrom, M.D., Minneapolis, Minn.:

► "Panoptx sunglasses can be helpful for symptomatic dry eye patients wearing contact lenses. These fashionable glasses, designed by a maxillofacial surgeon, feature a foam eyecup that protects the eye from evaporation during outdoor activities; filtered venting prevents fogging; and the glasses block 100% of UV light. Seven styles, designed to fit six different facial structures, are available.

"In a study of 110 dry eye patients conducted by myself and Douglas Weberling, O.D., the percentage of patients who ranked their symptoms as severe dropped from 50% to 3% after wearing Panoptx for 1 month; 30% of the subjects reported that their overall symptoms were completely eliminated when wearing the glasses." (Dr. Lindstrom has no financial interest in Panoptx or its products.)

► "Use of a safe steroid like lote-prednol at the end of the day after contact removal can soothe the eyes and reduce problematic symptoms."

Gary N. Foulks, M.D., Louisville, Ky.:

► "Tear film instability associated with meibomian gland dysfunction is a common cause of contact lens intolerance. To help minimize this, I have these patients apply a hot compress to the eyelids for about one and a half minutes upon waking. Next, they massage the lids by stretching the eyelid to the temporal canthus with the index finger of one hand while firmly applying the index finger of the other hand across the stretched eyelids four or five times. Then they can insert their contact lenses.

"Doing this two or three times a week improves comfort for about 80% of these patients."

Mitchell Friedlaender, M.D., La Jolla, Calif.:

► "Cevimeline HCl (Evoxac, Daiichi Pharmaceutical Corpora-tion) and pilocarpine hydrochloride (Salagen, MGI Pharmaceuticals) are oral medications that can be used to increase both saliva and tear production. Evoxac is FDA-approved for the treatment of dry mouth symptoms in patients with Sjögren's syndrome; Salagen is indicated for the treatment of symptoms of dry mouth.

"Generally we only resort to these medications when the dry eye problem is severe, but they can provide relief for dry eye patients who want or need to continue wearing their contact lenses."