Contact Lens Wear and Dry Eye: Beyond the Known : The Asia-Pacific Journal of Ophthalmology

Secondary Logo

Journal Logo

Review Article

Contact Lens Wear and Dry Eye: Beyond the Known

Koh, Shizuka MD, PhD∗,†

Author Information
Asia-Pacific Journal of Ophthalmology 9(6):p 498-504, November-December 2020. | DOI: 10.1097/APO.0000000000000329
  • Open


Contact lenses are widely used to correct refractive errors. According to the annual overviews of contact lens prescription trends, which surveyed contact lens fits from >20,000 cases from 25 countries in 2019,1 soft contact lenses (SCLs) were prescribed in 87% of the cases, whereas gas-permeable lenses are supplied in 13% of fits (conventional lenses, 10%; orthokeratology lenses, 3%).

This review primarily summarizes information from the latest topics related to contact lens and dry eye that would be useful for clinicians and contact lens practitioners, along with a concise review of what is known. Pitfalls that may be encountered in clinical practice and other associated topics are also described. Since most contact lenses prescribed today are SCLs, the contact lenses discussed in this review refer to SCLs.


Contact lens wear is one of the relevant risk factors for dry eye.2,3 Symptoms of discomfort and dryness are more frequent and intense in SCL wearers and exhibit a greater increase in intensity during lens usage than in nonwearers.4,5 Since the publication of the Contact Lens Discomfort (CLD) report by the 2013 Tear Film and Ocular Surface Society (TFOS) Workshop, its importance has continued to grow. The CLD report defines CLD as “a condition characterized by episodic or persistent adverse ocular sensations related to lens wear, either with or without visual disturbance, resulting from reduced compatibility between the contact lens and the ocular environment, which can lead to decreased wearing time and discontinuation of contact lens wear.”6 However, contact lens practitioners have used a variety of terms to describe this condition, and there is no standard definition. The CLD report describes some specific and relevant terminology that should be considered for such cases.6 CLD occurs while contact lenses are worn, and their removal mitigates the condition (especially the adverse ocular sensations). The terms “contact lens dry eye,” “contact lens-related dry eye,” or “contact lens-induced dry eye” should be reserved for cases with a preexisting dry eye condition that may be exaggerated by contact lens wear and should not be used when talking about CLD. “Contact lens dropout” refers to discontinuation of contact lens wear for a sustained period of time. In keeping with the definition proposed by the CLD report, CLD will be used throughout the review rather than “contact lens dry eye.”


Uneven or insufficient tear distribution and increased friction are the 2 main factors underlying CLD.7 A simplified scheme is shown in Figure 1. Once a contact lens is placed on the eye, the tear film is divided into the pre-lens tear film (PLTF) and post-lens tear film (PoLTF). Although the PLTF is less stable and thinner than the tear film over the cornea,8 it plays an important role in providing a smooth optical surface; it also provides comfort and lubrication to the palpebral conjunctiva, reducing the friction between the lens and palpebral conjunctiva. The PoLTF may be involved in interactions with the ocular surface and affect ocular comfort during contact lens wear.9 In addition, through tear exchange, the PoLTF removes the cellular and inflammatory debris contained within the lens itself. Tear evaporation rates associated with SCL use are high, even if SCL wearers are asymptomatic.10 Therefore, patients who previously did not experience symptoms may develop symptoms of discomfort and dryness.11 For successful contact lens wear, both the PLTF and PoLTF are important in maintaining ocular health. Multiple biophysical changes associated with this compartmentalization can occur in the tear film during SCL wear, which will be discussed later.9 Moreover, a possible increase in friction between the lens and lid wiper, or between the lens edge and bulbar conjunctiva, should be considered.

Simplified scheme for the mechanism of contact lens discomfort (CLD). Uneven or insufficient tear distribution and increased friction are the two main factors underlying CLD development.

A recent review suggested clinical and subclinical inflammation associated with contact lens wear,12,13 and summarized the evidence of inflammation during uncomplicated contact lens wear for both hydrogel and silicone hydrogel lenses.13


Ocular surface symptoms are a feature of CLD. A contact lens dry eye questionnaire is the most likely candidate for large-scale CLD assessment, and the Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8)14,15 is reported to represent the most validated measure of these symptoms.16 The CLDEQ-8 is an 8-item self-administered questionnaire that queries the frequency and late-day intensity of discomfort, dryness, blurry vision; the frequency of closing eyes for relief while wearing contact lenses; and the removal of lenses earlier than planned for relief of symptoms. It also reflects the wearers’ overall opinion of contact lenses, eye dryness, and eye sensitivity. The CLDEQ-8 (originally in English) was recently translated into different languages, and validation studies of the versions translated in Spanish, Japanese, and Turkish have been reported.17–19 Although both the Japanese18 and Turkish19 versions were valid and reliable, elaboration was required for the Spanish17 version. Interestingly, eye dryness, but not eye sensitivity, was useful to capture the symptoms in the Japanese populations.18 A study20 to develop and validate a Chinese version of the ocular comfort index21 reported that “grittiness” and “stinging” were difficult to interpret in Chinese. These studies17–20 imply that linguistic features and cultural differences should be carefully interpreted and considered during the development of questionnaires translated from a different language.

The prevalence of CLD and dryness symptoms in SCL wearers is reported to be approximately 50%.22 In a recent study from Japan, >70% of SCL wearers reported eye dryness.18 Digital device usage for both social and professional purposes has recently shown a remarkable increase across all age groups. Moreover, the current coronavirus disease 2019 (COVID-19) pandemic has accelerated the increased use of digital devices and screen time for both work and recreation around the world, which may lead to an increase in eye strain. Digital eye strain includes a range of ocular and visual symptoms, and its prevalence is reported to be ≥50% among computer users.23 Digital eye strain symptoms can be mainly classified into those associated with dry eye or those related to accommodation.23–25 With ≥6 hours of computer use, contact lens wearers were more likely to be affected than nonwearers, with prevalences of 65% and 50%, respectively.23


In accordance with the protocols suggested by both the Dry Eye Workshop (DEWS) II report and Asia Dry Eye Society (ADES) consensus report,3,26 proper assessment of the ocular surface, tear film, and symptom questionnaire are essential. Note the difference in the diagnostic criteria for dry eye between DEWS II and ADES. The recommended criteria for dry eye diagnosis by DEWS II are presence of symptoms and at least one positive result for homeostasis markers (decreased noninvasive tear breakup time, increased osmolarity, or a certain amount of ocular surface damage).26 In contrast, on the basis of ADES, dry eye can be diagnosed by a combination of symptoms and an unstable tear film (decreased tear breakup time). Actually, it is highly dependent on tear film stability.3 Several biophysical tear film changes associated with SCL wear are known, including increased evaporation, decreased tear film stability, reduced pre-lens lipid layer thickness, decreased tear volume, and changes in the tear composition.11 However, their influence on comfort remains unproven and inconclusive, and further investigation is needed.

Geographical and/or ethnicity-related differences in the susceptibility to dry eye have been reported, and Asian ethnicity is a risk factor for dry eye.27 Similarly, Asian ethnicity is associated with discomfort and dryness with contact lens wear.27 Interestingly, among non-Asians, dryness symptoms were more severe in the presence of corneal staining, whereas dryness severity did not appear to be related to corneal staining among Asians.28

The lack of in-depth investigations into the subtypes, causes, and contributing factors of the presenting dry eye results in relation to patient dissatisfaction has been addressed. According to a recent study, both asymptomatic and symptomatic SCL wearers who are asymptomatic without lenses exhibit similar clinical signs.29


Evaluation of the ocular surface and tear film of all contact lens wearers is essential, even when these individuals are asymptomatic. Makeup particles floating in the tear film and makeup residue in the eyelid margin are sometimes observed in female SCL wearers, which may be trapped by SCLs and may disturb vision. The migration of cosmetic products across the eyelid margin has been reported,30 and is thought to exacerbate tear film instability and symptoms of dry eye.31 Since eye cosmetics are frequently applied among female populations, who also constitute the majority of contact lens wearers, educational guidance regarding eye cosmetic usage with SCL wear should be appropriately provided.

To evaluate corneal or conjunctival epithelium damage, vital staining procedures are simple and useful. Fluorescein staining can be applied without special tools or devices. With fluorescein staining, a cobalt blue filter is typically used during slit-lamp examination; these filters transmit blue light, which activates the fluorescein dye. To enhance the visualization of the fluorescent tear film and staining, a yellow filter or a blue-free barrier filter can be used.32–34 This filter is especially useful in detecting conjunctival epithelial damage. Manufacturers have incorporated such yellow filters into their slit-lamps. The smile pattern of corneal staining in the inferior cornea is reported to be a characteristic corneal staining pattern in SCL wearers,35 whereas 3 to 9 o’clock staining is a characteristic pattern in rigid gas-permeable contact lens wearers36–38 (Fig. 2). Some SCL wearers are asymptomatic even with more than moderate corneal staining and state that they feel better with SCL wear. This can be attributed to the masking effect of SCLs.

(Left) Smile pattern of corneal staining is characteristic in soft contact lens wearers. (Right) 3–9 o’clock staining is characteristic in rigid gas-permeable contact lens wearers.

Lissamine green dye is widely used to stain the conjunctiva and assess its health. It provides information similar to the more traditional rose bengal dye, without discomfort for the patient. The conjunctiva responds in various ways to contact lens wear. Bulbar conjunctival staining with lissamine green is associated with CLD, particularly SCL edge-related staining. In addition, it has been reported that evaporation due to destabilization of the tear film by the SCL causes bulbar conjunctival staining.39–43 The palpebral conjunctiva is important in controlling the interaction between the ocular surface and lens. Identification of the presence of lid wiper epitheliopathy (LWE) linked to CLD is important, but is unfortunately easily overlooked (Fig. 3). Korb et al44 first introduced the term “lid wiper” to describe the area of the upper eyelid that spreads tear film over the cornea (or contact lens), and the term “lid wiper epitheliopathy” refers to the disruption of epithelial cell integrity in this area. Increased staining of the upper-lid margin has been reported in contact lens wearers with symptoms of dryness.44,45 Another study reported that LWE was found in 67% and 32% of symptomatic and asymptomatic SCL wearers, respectively.46 The pathophysiology of LWE is thought to involve increased friction between the lid wiper area and the surface of either the cornea or contact lens as a result of inadequate lubrication.47

Lid wiper epitheliopathy is identified with fluorescein staining. Courtesy to Dr. Hisayo Higashihara.


The following management strategies for CLD have been suggested by the CLD report48: change in the care solution and care system, adjustment of replacement schedule, change in lens design or material, tear supplementation (use of lubricating or wetting drops, and punctal plug insertion), dietary supplementation, and improvement of environment. Since then, several different contact lenses or contact lens care products and dry eye treatment eye drops have been introduced in the market. Dietary supplementation with oral omega-3 fatty acids was recommended by clinicians to relieve dry eye symptoms, with the assumption that they have antiinflammatory activity and are not associated with substantial side effects.49 However, the results of the 12-month Dry Eye Assessment and Management study revealed that dietary supplementation with oral omega-3 fatty acids is no better than placebo in relieving the signs and symptoms of dry eye.50 The results of their extension study were consistent with the primary trial.51 Therefore, updates to the current or latest strategy are essential.

Whether patients with CLD qualify for refractive surgery requires careful consideration and counseling of the individual patient. The surgical procedure itself is commonly associated with dry eye in the postsurgical period.52,53 According to a questionnaire survey, 23% of refractive surgery patients who were previous contact lens wearers cited dry eyes as the reason for their decision to receive refractive surgery.54 Moreover, visual performance during concentrated visual work and quality of life were reported to be worse with SCL wear than after laser in situ keratomileusis.55,56

The treatment strategy in our clinical practice can be classified into two approaches: pharmacological treatment (approach focused on the ocular surface) or selection of suitable contact lens (approach focused on the contact lens). In cases where discontinuation of contact lens wear is desirable, we ask the patient to stop contact lens wear. If contact lens wear is thought to be possible with concomitant eye drop usage for dry eye treatment, the possibility of discontinuation of contact lens wear should be thoroughly explained first. The transient enhancement of tear film stability by SCL lubricants is unlikely to provide a basis for prolonged symptomatic relief.57,58

Pharmacological Treatment

Based on the mechanism mentioned earlier in this review, treatment focuses on the management of uneven or insufficient tear distribution and increased friction. With the introduction of 3% diquafosol sodium ophthalmic solution (Diquas ophthalmic solution 3%; Santen Pharmaceutical Co., Osaka, Japan) and 2% rebamipide ophthalmic suspension (Mucosta Ophthalmic Suspension UD2%; Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan) both first in Japan, diagnosis and treatment of dry eye have advanced greatly. A new concept of layer-by-layer diagnosis and treatment for dry eye, termed “tear-film-oriented diagnosis” and “tear-film-oriented therapy” has been proposed.3,59 Currently (at the time of August 2020), diquafosol is approved and available in Japan, South Korea, China, Taiwan, Philippines, Thailand, Malaysia, Indonesia, and Vietnam. Rebamipide is available only in Japan.

To treat uneven or insufficient tear distribution, diquafosol, which promotes aqueous and mucin secretion from the conjunctiva, is expected to be effective. It is reported to increase the tear meniscus height in SCL wearers.60 Using a rabbit model of SCL wear, both the PLTF and PoLTF thickness were reported to increase after diquafosol instillation.61 Moreover, 4-week treatment with diquafosol improved tear stability, ocular surface vital staining score, and subjective symptoms.62 Rebamipide, which increases the secretory mucin level, is reported to be effective in treating friction-related ocular surface disorders such as superior limbic keratoconjunctivitis and LWE,63,64 probably because of the gradual increase in goblet cells.65 Rebamipide is reported to be effective in improving discomfort associated with SCL wear.66,67 This effect is thought to involve a reduction of the increased friction associated with SCL wear. This strategy is based on the available treatment in Japan where the author is involved in clinical practice.

To date, there have been no published studies investigating the efficacy of topical steroid treatment for CLD.48 Except for dry eye associated with immune system diseases, the role of topical steroids is either unclear or contradictory for the treatment of dry eye and related conditions.68

Selection of Suitable Contact Lens

Daily disposable lenses with good lens wettability would be a great option for SCL wearers with dry eyes, partly because contact lenses are prone to developing surface deposits over time.69,70 The choice between silicone hydrogel and hydrogel has been a matter of constant debate and the subject of several comparative studies. However, the choice depends on the individual eye, and not all eyes are fitted with the latest or high-end model contact lens.

Silicone hydrogel was commercially introduced as a contact lens material in the late 1990 s.71–73 First-generation silicone hydrogels for extended wear were expected to address the issue of oxygen permeability during continuous wear; however, these lenses had lower water content and higher modulus than the hydrogel lenses, which made them stiffer and sometimes caused mechanical complications. Efforts to minimize the mechanical issues causing discomfort and the adverse events associated with silicone hydrogel have led to the development of silicone hydrogel daily disposable lenses, which combine the advantages of the silicone hydrogel material and the daily disposable modality. The prescription rate of silicone hydrogel lenses has been increasing worldwide. According to the international contact lens prescription trends in 2019, the proportion of silicone hydrogels used for daily disposable lenses continues to rise and is currently at 62%.1 The 1-Day Acuvue TruEye or 1-Day Acuvue Moist Brands Performance Overview (TEMPO) registry found low rates of adverse events associated with daily disposable lenses of both types and improved safety outcomes with daily disposable contact lenses.74 This supports the previous finding that overnight wear continues to be the major risk factor for microbial keratitis.75 According to a recent study comparing subjective, objective, and safety performance of silicone hydrogel daily disposable with hydrogel daily disposable contact lenses,76 there was no difference in discomfort, and the adverse event rates were low with both lenses. Limbal redness was more frequent in hydrogel lenses, whereas conjunctival staining and indentation were more frequently observed in silicone hydrogel lenses. Thus, the choice of material may be based on patient and practitioner preference.

Visual disturbances manifesting as blurring or fluctuating vision are common in CLD, and can affect visual performace.4 Quantitative objective measurements have suggested that the material and water content of the contact lens may affect surface lens wettability and its interactions with the ocular tear film, which can influence optical quality.77–81 Sequential measurements of higher-order aberrations have evaluated the effect of internal wetting agents and contact lens material on the on-eye optical quality.77,80,81 According to a series of studies, both daily disposable hydrogel or silicone hydrogel lenses with novel internal wetting agents yield a better and more stable optical quality compared to hydrogel lens without the added wetting agent.77,81 These findings also suggest that the choice of material may be based on patient and practitioner preference.76 Alternatively, SCL wearers with CLD could switch to using rigid gas-permeable contact lenses. However, to date, there have been no published evidence-based studies supporting this.48


Safety, comfort, and good visual performance should be prioritized for contact lens wear. Because of the enormous efforts by contact lens manufacturers, safety has been achieved. However, comfort is greatly dependent on the eye condition of the wearers. Visual performance is also related to comfort since visual symptoms are a part of CLD; these are the challenges associated with CLD. In dry eye, the weak association between clinical signs and symptoms has been a bottleneck in diagnosis and management.82–85 With the growing field of contact lens technology and pharmacological developments for dry eye, many possible improvements can be expected to manage CLD in the future.


The author thanks Hisayo Higashihara, MD, PhD (Higashihara Clinic, Kyoto, Japan) for providing clinical photo images.


1. Available at: Accessed August 10, 2020.
2. Gomes JAP, Azar DT, Baudouin C, et al. TFOS DEWS II iatrogenic report. Ocul Surf 2017; 15:511–538.
3. Tsubota K, Yokoi N, Shimazaki J, et al. New perspectives on dry eye definition and diagnosis: a consensus report by the Asia Dry Eye Society. Ocul Surf 2017; 15:65–76.
4. Begley CG, Chalmers RL, Mitchell GL, et al. Characterization of ocular surface symptoms from optometric practices in North America. Cornea 2001; 20:610–618.
5. Chalmers RL, Begley CG. Dryness symptoms among an unselected clinical population with and without contact lens wear. Cont Lens Anterior Eye 2006; 29:25–30.
6. Nichols KK, Redfern RL, Jacob JT, et al. The TFOS International Workshop on Contact Lens Discomfort: report of the definition and classification subcommittee. Invest Ophthalmol Vis Sci 2013; 54:TFOS14–TFOS19.
7. Koh S. Treatment of contact lens discomfort. J Jpn CL Soc 2019; 61:30–32.
8. Kojima T. Contact lens-associated dry eye disease: recent advances worldwide and in Japan. Invest Ophthalmol Vis Sci 2018; 59:DES102–DES108.
9. Craig JP, Willcox MD, Argüeso P, et al. The TFOS International Workshop on Contact Lens Discomfort: report of the contact lens interactions with the tear film subcommittee. Invest Ophthalmol Vis Sci 2013; 54:123–156.
10. Guillon M, Maissa C. Contact lens wear affects tear film evaporation. Eye Contact Lens 2008; 34:326–330.
11. Nichols JJ, Sinnott LT. Tear film, contact lens, and patient-related factors associated with contact lens-related dry eye. Invest Ophthalmol Vis Sci 2006; 47:1319–1328.
12. Efron N. Is contact lens wear inflammatory? Br J Ophthalmol 2012; 96:1447–1448.
13. Efron N. Contact lens wear is intrinsically inflammatory. Clin Exp Optom 2017; 100:3–19.
14. Chalmers RL, Begley CG, Moody K, et al. Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) and opinion of contact lens performance. Optom Vis Sci 2012; 89:1435–1442.
15. Chalmers RL, Keay L, Hickson-Curran SB, et al. Cutoff score and responsiveness of the 8-item Contact Lens Dry Eye Questionnaire (CLDEQ-8) in a large daily disposable contact lens registry. Cont Lens Anterior Eye 2016; 39:342–352.
16. Foulks G, Chalmers R, Keir N, et al. The TFOS International Workshop on Contact Lens Discomfort: report of the subcommittee on clinical trial design and outcomes. Invest Ophthalmol Vis Sci 2013; 54:TFOS157–TFOS183.
17. Garza-Leon M, Amparo F, Ortíz G, et al. Translation and validation of the contact lens dry eye questionnaire-8 (CLDEQ-8) to the Spanish language. Cont Lens Anterior Eye 2019; 42:155–158.
18. Koh S, Chalmers R, Kabata D, et al. Translation and validation of the 8-item Contact Lens Dry Eye Questionnaire (CLDEQ-8) among Japanese soft contact lens wearers: The J-CLDEQ-8. Cont Lens Anterior Eye 2019; 42:533–539.
19. Dogan AS, Karabulut E, Gurdal C. Validation and reliability of the Turkish version of Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) [published online ahead of print, 2020 Feb 26]. Cont Lens Anterior Eye 2020; S1367-0484:30020–30025.
20. Chao C, Golebiowski B, Cui Y, et al. Development of a Chinese version of the ocular comfort index. Invest Ophthalmol Vis Sci 2014; 55:3562–3571.
21. Johnson ME, Murphy PJ. Measurement of ocular surface irritation on a linear interval scale with the ocular comfort index. Invest Ophthalmol Vis Sci 2007; 48:4451–4458.
22. Dumbleton K, Caffery B, Dogru M, et al. The TFOS International Workshop on Contact Lens Discomfort: report of the subcommittee on epidemiology. Invest Ophthalmol Vis Sci 2013; 54:TFOS20–TFOS36.
23. Sheppard AL, Wolffsohn JS. Digital eye strain: prevalence, measurement and amelioration. BMJ Open Ophthalmol 2018; 3:e000146doi:10.1136/bmjophth-2018-000146.
24. Portello JK, Rosenfield M, Bababekova Y, et al. Computer-related visual symptoms in office workers. Ophthal Physiol Optics 2012; 32:375–382.
25. Sheedy JE, Hayes JN, Engle J. Is all asthenopia the same? Optom Vis Sci 2003; 80:732–739.
26. Wolffsohn JS, Arita R, Chalmers R, et al. TFOS DEWS II diagnostic methodology report. Ocul Surf 2017; 15:539–574.
27. Stapleton F, Alves M, Bunya VY, et al. TFOS DEWS II epidemiology report. Ocul Surf 2017; 15:334–365.
28. Tran N, Graham AD, Lin MC. Ethnic differences in dry eye symptoms: effects of corneal staining and length of contact lens wear. Cont Lens Anterior Eye 2013; 36:281–288.
29. Molina K, Graham AD, Yeh T, et al. Not all dry eye in contact lens wear is contact lens-induced. Eye Contact Lens 2020; 46:214–222.
30. Ng A, Evans K, North RV, et al. Migration of cosmetic products into the tear film. Eye Contact Lens 2015; 41:304–309.
31. Wang MT, Craig JP. Investigating the effect of eye cosmetics on the tear film: current insights. Clin Optom (Auckl) 2018; 10:33–40.
32. Courtney R, Lee J. Predicting ocular intolerance of a contact lens solution by use of a filter system enhancing fluorescein staining detection. Int Contact Lens Clin 1982; 9:302–310.
33. Bron AJ. Diagnosis of dry eye. Surv Ophthalmol 2001; 45: (suppl 2): S221–S226.
34. Koh S, Watanabe H, Hosohata J, et al. Diagnosing dry eye using a blue-free barrier filter. Am J Ophthalmol 2003; 136:513–519.
35. Watanabe K, Hamano H. The typical pattern of superficial punctate keratopathy in wearers of extended wear disposable contact lenses. CLAO J 1997; 23:134–137.
36. Bennett ES. Silicone/acrylate lens design. Int Cont Lens Clin 1985; 12:45–53.
37. Lowther GE. Review of rigid contact lens design and effects of design and lens fit. Int Cont Lens Clin 1988; 15:378–389.
38. van der Worp E, de Brabander J. Contact lens fitting today part one: modern RGP lens fitting. Optom Today 2005; 15:27–32.
39. Maissa C, Guillon M, Garofalo RJ. Contact lens-induced circumlimbal staining in silicone hydrogel contact lenses worn on a daily wear basis. Eye Contact Lens 2012; 38:16–26.
40. Maldonado-Codina C, Morgan PB, Schnider CM, et al. Short-term physiologic response in neophyte subjects fitted with hydrogel and silicone hydrogel contact lenses. Optom Vis Sci 2004; 81:911–921.
41. Lakkis C, Brennan NA. Bulbar conjunctival fluorescein staining in hydrogel contact lens wearers. CLAO J 1996; 22:189–194.
42. Morgan PB, Chamberlain P, Moody K, et al. Ocular physiology and comfort in neophyte subjects fitted with daily disposable silicone hydrogel contact lenses. Cont Lens Anterior Eye 2013; 36:118–125.
43. Guillon M, Maissa C. Bulbar conjunctival staining in contact lens wearers and non lens wearers and its association with symptomatology. Cont Lens Anterior Eye 2005; 28:67–73.
44. Korb DR, Greiner JV, Herman JP, et al. Lid-wiper epitheliopathy and dry-eye symptoms in contact lens wearers. CLAO J 2002; 28:211–216.
45. Pult H, Purslow C, Berry M, et al. Clinical tests for successful contact lens wear: relationship and predictive potential. Optom Vis Sci 2008; 85:E924–E929.
46. Yeniad B, Beginoglu M, Bilgin LK, et al. Lid-wiper epitheliopathy in contact lens users and patients with dry eye. Eye Contact Lens 2010; 36:140–143.
47. Korb DR, Herman JP, Greiner JV, et al. Lid wiper epitheliopathy and dry eye symptoms. Eye Contact Lens 2005; 31:2–8.
48. Papas EB, Ciolino JB, Jacobs D, et al. The TFOS International Workshop on Contact Lens Discomfort: report of the management and therapy subcommittee. Invest Ophthalmol Vis Sci 2013; 54:TFOS183–TFOS203.
49. Serhan CN, Chiang N, Van Dyke TE. Resolving inflammation: dual anti-inflammatory and pro-resolution lipid mediators. Nat Rev Immunol 2008; 8:349–361.
50. Asbell PA, Maguire MG, Pistilli M, et al. Dry Eye Assessment and Management Study Research Group. n-3 fatty acid supplementation for the treatment of dry eye disease. N Engl J Med 2018; 378:1681–1690.
51. Hussain M, Shtein RM, Pistilli M, et al. The Dry Eye Assessment and Management (DREAM) extension study - A randomized clinical trial of withdrawal of supplementation with omega-3 fatty acid in patients with dry eye disease. Ocul Surf 2020; 18:47–55.
52. De Paiva CS, Chen Z, Koch DD. The incidence and risk factors for developing dry eye after myopic LASIK. Am J Ophthalmol 2006; 141:438–445.
53. Murakami Y, Manche EE. Prospective, randomized comparison of self-reported postoperative dry eye and visual fluctuation in LASIK and photorefractive keratectomy. Ophthalmology 2012; 119:2220–2224.
54. Gupta N, Naroo SA. Factors influencing patient choice of refractive surgery or contact lenses and choice of centre. Cont Lens Anterior Eye 2006; 29:17–23.
55. Toda I, Yoshida A, Sakai C, et al. Visual performance after reduced blinking in eyes with soft contact lenses or after LASIK. J Refract Surg 2009; 25:69–73.
56. Queirós A, Villa-Collar C, Gutiérrez AR, et al. Quality of life of myopic subjects with different methods of visual correction using the NEI RQL-42 questionnaire. Eye Contact Lens 2012; 38:116–121.
57. Golding TR, Efron N, Brennan NA. Soft lens lubricants and prelens tear film stability. Optom Vis Sci 1990; 67:461–465.
58. Efron N, Golding TR, Brennan NA. The effect of soft lens lubricants on symptoms and lens dehydration. CLAO J 1991; 17:114–119.
59. Yokoi N, Georgiev GA. Tear film-oriented diagnosis and tear film-oriented therapy for dry eye based on tear film dynamics. Invest Ophthalmol Vis Sci 2018; 59:DES13–DES22.
60. Nagahara Y, Koh S, Maeda N, et al. Prominent decrease of tear meniscus height with contact lens wear and efficacy of eye drop instillation. Eye Contact Lens 2015; 41:318–322.
61. Nagahara Y, Koh S, Oshita Y, et al. Diquafosol ophthalmic solution increases pre- and postlens tear film during contact lens wear in rabbit eyes. Eye Contact Lens 2017; 43:378–382.
62. Shigeyasu C, Yamada M, Akune Y, et al. Diquafosol for soft contact lens dryness: clinical evaluation and tear analysis. Optom Vis Sci 2016; 93:973–978.
63. Takahashi Y, Ichinose A, Kakizaki H. Topical rebamipide treatment for superior limbic keratoconjunctivitis in patients with thyroid eye disease. Am J Ophthalmol 2014; 157:807–812.
64. Itakura H, Kashima T, Itakura M, et al. Topical rebamipide improves lid wiper epitheliopathy. Clin Ophthalmol 2013; 7:2137–2141.
65. Kase S, Shinohara T, Kase M. Effect of topical rebamipide on human conjunctival goblet cells. JAMA Ophthalmol 2014; 132:1021–1022.
66. Shigeyasu C, Yamada M, Akune Y, et al. The effect of rebamipide ophthalmic suspension on ocular surface mucins in soft contact lens wearers. Cont Lens Anterior Eye 2018; 41:357–361.
67. Igarashi T, Kobayashi M, Yaguchi C, et al. Efficacy of rebamipide instillation for contact lens discomfort with dry eye. Eye Contact Lens 2018; 44:S137–S142.
68. Tsubota K, Yokoi N, Watanabe H, et al. A new perspective on dry eye classification: proposal by the Asia Dry Eye Society. Eye Contact Lens 2020; 46:S2–S13.
69. Luensmann D, Jones L. Protein deposition on contact lenses: the past, the present, and the future. Cont Lens Anterior Eye 2012; 35:53–64.
70. Mann A, Tighe B. Contact lens interactions with the tear film. Exp Eye Res 2013; 117:88–98.
71. Dumbleton K. Adverse events with silicone hydrogel continuous wear. Cont Lens Anterior Eye 2002; 25:137–146.
72. Sweeney D, Du Toit R, Keay L. Sweeney D, et al. Clinical performance of silicone hydrogel lenses. Silicone Hydrogels: Continuous Wear Contact Lenses 2nd ed.Oxford: Butterworth-Heinemann; 2004. 164–216.
73. Stapleton F, Stretton S, Papas E, et al. Silicone hydrogel contact lenses and the ocular surface. Ocul Surf 2006; 4:24–43.
74. Chalmers RL, Hickson-Curran SB, Keay L, et al. Rates of adverse events with hydrogel and silicone hydrogel daily disposable lenses in a large postmarket surveillance registry: the TEMPO registry. Invest Ophth Vis Sci 2015; 56:654–663.
75. Stapleton F, Keay L, Edwards K, et al. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology 2008; 115:1655–1662.
76. Diec J, Tilia D, Thomas V. Comparison of silicone hydrogel and hydrogel daily disposable contact lenses. Eye Contact Lens 2018; 44:S167–S172.
77. Koh S, Maeda N, Hamano T, et al. Effect of internal lubricating agents of disposable soft contact lenses on higher-order aberrations after blinking. Eye Contact Lens 2008; 34:100–105.
78. Szczesna-Iskander DH, Iskander DR, Read SA, et al. Noninvasive in vivo assessment of soft contact lens type on tear film surface quality. Invest Ophthalmol Vis Sci 2012; 53:525–531.
79. Montés-Micó R, Belda-Salmerón L, Ferrer-Blasco T, et al. On-eye optical quality of daily disposable contact lenses for different wearing times. Ophthalmic Physiol Opt 2013; 33:581–591.
80. Koh S, Higashiura R, Maeda N. Overview of objective methods for assessing dynamic changes in optical quality. Eye Contact Lens 2016; 42:333–338.
81. Koh S, Watanabe K, Nishida K. Objective evaluation of on-eye optical quality of daily disposable silicone hydrogel contact lens with internal wetting agents. Clin Ophthalmol 2019; 13:2159–2165.
82. Nichols KK, Nichols JJ, Mitchell GL. The lack of association between signs and symptoms in patients with dry eye disease. Cornea 2004; 23:762–770.
83. Mizuno Y, Yamada M, Miyake Y. Association between clinical diagnostic tests and health-related quality of life surveys in patients with dry eye syndrome. Jpn J Ophthalmol 2010; 54:259–265.
84. Sullivan BD, Crews LA, Messmer EM. Correlations between commonly used objective signs and symptoms for the diagnosis of dry eye disease: clinical implications. Acta Ophthalmol 2014; 92:161–166.
85. Schmidl D, Witkowska KJ, Kaya S, et al. The association between subjective and objective parameters for the assessment of dry-eye syndrome. Invest Ophthalmol Vis Sci 2015; 56:1467–1472.

contact lens; contact lens discomfort; dry eye

Copyright © 2020 Asia-Pacific Academy of Ophthalmology. Published by Wolters Kluwer Health, Inc. on behalf of the Asia-Pacific Academy of Ophthalmology.