Poor lens hygiene, overwear and not being seen regularly by the prescribing optometrist can contribute to contact lens intolerance.

Giant papillary conjunctivitis from contact lenses is a condition where small bumps form on the underside of the upper lid. The classic symptom described is “every time I blink my contact lens moves”. The cause is often protein deposition on the lens. A contact lens “holiday” along with appropriate treatment prescribed by a prescribing optometrist or ophthalmologist will help reduce the bumps and can take a couple of months. Switching over to daily disposable soft contact lenses may well avoid a recurrence.

Allergic conjunctivitis is often seasonal (Spring when the pollen is out) and results in excessive tearing, itching and eye redness. Sodium Cromoglycate eye drops (available over the counter) is a first line treatment. In severe cases steroids may be required but will need a prescription from an ophthalmologist who has evaluated the condition. Allergies to contact lens solutions can be a cause of intolerance. A simple option is to try an alternate storage solution. A trial of disposable lenses may be the easiest option going forward.

Dry eye is a common cause of which there are a multitude of causes. The most common and one that increases in likelihood with age is evaporative dry eye as a result of meibomian gland disease. This is where oil producing glands shaped like piano keys become clogged up and stop secreting necessary oils that maintain stability of the tear film on the surface of the eye. The oils can break down into fatty acids which burn and cause inflammation and irritation after wearing contact lenses. Additionally stagnant oils serve as food for opportunistic organisms like bacteria and parasites (Demodex) which in turn can cause even more inflammation and irritation.

Dry eye can be “underproductive” whereby the lacrimal glands reduce the amount of liquid being secreted. Reduced secretion does occur in contact lens wearers because of reduced sensitivity on the eye surface. The balance of production vs. need for tears can sometimes be tipped over resulting in CLI. Contributing factors include advancing age and hormonal changes as can autoimmune conditions like Rheumatoid arthritis.

To understand the specific causes of dry eye, specific tests are conducted followed by a good clinical evaluation. Treatment advised will be based on the findings. The specific cause/s of the condition can be addressed and once resolved may well reduce the level of intolerance experienced. There are a variety of treatments for dry eye.