4 Reasons Contact Lenses May Not Be for You

Ready to trade your eyeglasses for contact lenses? Many people excitedly make an appointment to try contact lenses, only to be told they shouldn't wear them. Several factors may or may not make you a good candidate. Your optometrist or ophthalmologist will perform a comprehensive eye examination and conduct certain tests to determine if contact lenses will work for you. While wearing contact lenses isn't a problem for most people, there are a few conditions that may make it difficult.

Dry Eye Syndrome

Dry eye syndrome is one of the most common conditions that gets in the way of successful contact lens wear. In order to feel comfortable in contact lenses, a person needs to have ample amounts of healthy tear film. Human tears consist of water, oil, mucus, salt, natural antibiotics, vitamins, minerals, and many other ingredients. Every time you blink, you renew your tears and wipe a new layer of this complicated solution across your eye. Tears help keep contact lenses moist and lubricated.

If tear film is lacking, the contact lens becomes dry, or the surface of the lens may be exposed to the air. This will cause fluctuating, blurry vision and will cause the eye to feel dry. You may feel the contact lens in your eye or feel as if there is a piece of sand in your eye. Your eye may feel scratchy or burn. These symptoms may leave your eyes feeling very irritated after only a few hours of wearing contacts.

What Can Be Done?

Severe dry eye syndrome presents a significant problem with wearing contact lenses. For most severe dry eye patients, contact lens wear is not a good option. Severe dry eye syndrome can cause not only significantly uncomfortable contact lens wear, but it can put a person at risk of corneal scarring and potential infection. However, mild to moderate dry eye patients can usually wear contact lenses, at least part of the time. To improve dry eye problems with contact lenses, your healthcare provider may try some or all of the following to improve the dry eye condition, or at least treat the symptoms so contact lens wear is more comfortable:

• Fitting a special water-gradient, daily disposable lens
• Fitting a special large scleral rigid contact lens
• Increasing use of artificial tear contact lens re-wetting drops
• Inserting plugs into the tear drainage canal (punctal occlusion)
• Giving a prescription medication such as Xiidra or Restasis

Blepharitis

Blepharitis is another common condition that reduces the chances of success with contact lens wear. Blepharitis is an inflammation of the eyelids. While it can affect people of any age, blepharitis tends to occur more often in people with oily skin. Blepharitis is classified into two types: anterior and posterior.

Anterior blepharitis: Anterior blepharitis affects the outside of the eyelid where the eyelashes attach. Anterior blepharitis can be seborrheic or ulcerative. Seborrheic blepharitis is associated with dandruff. This type typically causes the eyelids to become red and produce waxy scales on the eyelashes. It also may cause the eyes to itch. The scales initially develop due to an abnormal amount and type of tear film being produced by the glands of the eyelids. Ulcerative blepharitis is less common than seborrheic blepharitis and usually begins in childhood. It is caused by bacteria. Ulcerative blepharitis is a more severe form that causes hard crusts to form around the eyelashes. These crusts often become matted during sleep, making it difficult to open the eyes in the morning.

Anterior blepharitis can actually put one at risk for developing a significant eye infection while wearing contact lenses because of the amount of bacteria hanging around the eyelid. Plus, the crusty debris can spill over into the tear film and cause irritation and contact lens coating problems. In addition, manipulating the eyelids while inserting and removing contact lenses can cause more debris to be spread around, increasing redness.

Posterior blepharitis: Posterior blepharitis develops when oil glands in the inner eyelid allow bacteria to grow. It can occur as a result of skin conditions such as acne rosacea and scalp dandruff. Posterior blepharitis is also referred to as meibomian gland dysfunction. Meibomian gland dysfunction is a much more common type of blepharitis. Meibomian glands function to secrete a type of oil. With the force of a blink, oil is secreted into the tears. This oil is designed to prevent tear film evaporation. When these glands are inflamed, either too much or too little oil is being secreted. Posterior blepharitis also causes evaporative dry eye. Having dry eyes can make wearing contact lenses extremely difficult.

What Can Be Done? 

It is usually best to treat blepharitis before being fit for contact lenses. Most healthcare providers will prescribe eyelid scrubs and warm compresses. Blepharitis is treated by applying warm compresses with a very warm washcloth followed by eyelid scrubs. In the past, healthcare providers recommended using baby shampoo with a warm washcloth. The eye is closed and washed with the washcloth using a gentle back and forth motion. Baby shampoo is recommended because it does not sting your eyes, but it's fine to use another gentle soap if it doesn't irritate your eyes. Nowadays, commercially prepared lid scrubs are also available, but they tend to be expensive, so baby shampoo is still a good option. Other ways to treat blepharitis include:

• Fatty acids—Omega-3 fatty acids are shown to stabilize the meibomian glands and create an anti-inflammatory effect on the eye. It may take 3-6 months before a definite beneficial effect is seen.
• Topical antibiotics—Azithromycin is available in a topical form called Azasite. Healthcare providers will often tell patients to apply a small amount of Azasite to the eyelid margin with their finger at bedtime. Azasite tends to have an anti-inflammatory effect in addition to being anti-infective. Antibiotic ointments such as erythromycin and bacitracin are also prescribed, although they are a little thicker.
• Oral antibiotics—For stubborn cases, oral antibiotics may also be prescribed. Oral tetracycline, minocycline, or doxycycline prescribed anywhere from 30 days to much longer can be quite effective. This is particularly helpful for patients with a more severe form of blepharitis called ocular rosacea.
• Corticosteroids—Although steroids can bring unwanted side effects and risks, they are very effective at quelling inflammation when more traditional methods do not work. Healthcare providers will prescribe them for blepharitis for short-term inflammation control to minimize potential complications.

Severe Eye Allergies

Having severe eye allergies can create problems wearing contact lenses. The allergy cascade or reaction is often associated with triggers or antigens that make allergies flare up. An antigen can be allergens such as pollen, pet dander, dust mites, mold, cigarette smoke, perfume, or exhaust. When exposed to these allergens, cells in the eyes release histamines and other chemicals in an effort to protect the eyes. It is this chemical reaction that causes blood vessels inside the eyes to swell and the eyes to become itchy, red, and watery. There are different types of allergies, including the following:

• Seasonal and perennial allergic conjunctivitis
• Vernal keratoconjunctivitis
• Atopic keratoconjunctivitis

The most common types of eye allergies are seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC). These types of eye allergies cause the typical symptoms we are familiar with, such as itching, redness, tearing, swelling, burning, and clear, watery discharge.

More severe allergies, such as vernal and atopic keratoconjunctivitis, carry more risks. While it is not true that people suffering from these two types of allergic eye disease cannot wear contact lenses, doing so definitely carries with it more problems, since sometimes these conditions can affect the cornea to a significant degree and even cause scarring.

What Can Be Done?

The more severe the allergy, the less likely you will be a good candidate for contact lenses. One common treatment for general allergies is to take antihistamines. Antihistamines work wonders for those with allergies, but one detrimental side effect is that they dry out the mucus membranes, including those in the eyes. As a result, the eye is dry, and dry eyes make it difficult to wear contact lenses successfully. However, today we have very effective medications to control eye allergies, most in the form of eye drops. Steroids, antihistamines, and mast cell stabilizers are medications that can be prescribed by your optometrist or ophthalmologist to reduce symptoms.

Because allergens can stick to contact lenses and activate allergies, one method to reduce eye allergies is for the wearer to be fit with daily disposable contact lenses. These lenses are worn for a day or less and then disposed of. Every day you get a brand new, antigen-free lens to wear.

Giant papillary conjunctivitis (GPC) is a condition that is sometimes considered an allergy but is a bit different from environmental allergies. GPC is a condition in which the eye becomes allergic to a protein that precipitates out of the tears and onto the surface of a contact lens. The tissue under the upper eyelid becomes lumpy and bumpy and can grab hold of your contact lenses and move them around. People with GPC often complain of irritation and mucus discharge. GPC often develops in people who already wear contact lenses. This condition can usually be successfully treated.

Unusual Prescriptions

Eye doctors have a huge variety of parameters to choose from to fit contacts for patients who not only have nearsightedness or farsightedness, but also astigmatism and presbyopia. Optometrists have great products at their disposal. However, many people expect that they will receive the same quality of vision that they experience with their eyeglasses. Contact lenses do provide a new type of freedom, but for some people they do not always provide the sharpness and clarity that a high-quality pair of eyeglasses provides.

People with nearsightedness, farsightedness, and moderate amounts of astigmatism generally see as well with contacts as they do with glasses. However, high amounts of astigmatism are often more difficult to correct with soft contact lenses. Vision just never seems as crisp as it does with glasses. Although we have contact lenses for correcting near-vision problems due to presbyopia, such as monovision and multifocals, there is usually some level of compromise either at distance or near.

What Can Be Done?

Be willing to try several different diagnostic or trial lenses while being fit. The first pair you try doesn’t always work out. Most eye doctors will try three to four different types of lenses before considering other options like discontinuation of contact lenses. Listen to your healthcare provider if he or she recommends an alternative lens design besides regular soft lenses. Many of these options provide superior vision compared to soft disposable lenses. Some of these lenses include the following:

• Rigid gas permeable contact lenses
• Custom-designed astigmatism lenses by SpecialEyes.
• Hybrid lenses (part soft, part rigid) by Synergeyes.
• Scleral lenses
• Kerasoft lenses