In the present study, we evaluated the effects of the location of pigments in tinted lenses on the ocular surface by comparing tinted lenses with surface pigments, tinted lenses with embedded pigments, and clear lenses with regard to the ocular surface status, inflammatory cytokine levels in tear samples, and subjective symptom scores. Our results suggest that tinted soft contact lenses, particularly those with surface pigments, result in more adverse effects on the ocular surface.
Tinted soft contact lenses differ from conventional clear lenses in that they have an added pigment layer in the peripheral region. Infective keratitis associated with the use of cosmetic tinted contact lenses can be primarily attributed to the improper use of tinted lenses without professional consultation, primarily by adolescents, who are identified as the characteristic consumer population.2,3 Previous case reports have documented corneal pigmentation secondary to tinted lens wear and pigment deposition from tinted lenses after intense pulsed light treatment.11,12 Although the pigment location in tinted lenses has recently been suggested as another potential cause for complications associated with the use of tinted contact lenses,13,14 the correlation between the presence of surface pigments and adverse events associated with tinted lens wear is not fully investigated.
A report has stressed on the importance of the pre-lens tear film, which affects ocular comfort,15 and how it is affected by the pigment location in tinted lenses through alteration of the surface roughness and lens wettability. Therefore, we evaluated the effect of the location of pigment layers in tinted soft contact lenses on the human ocular surface through comparisons with clear lenses.
Several studies related to the ocular inflammatory response after contact lens wear have been published.16–19 González-Pérez et al.17 compared tear film inflammatory mediator levels between silicone–hydrogel and rigid contact lenses. Efron also used confocal microscopy to examine the density of Langerhans cells after contact lens wear and confirmed a subclinical inflammatory response.20 Our study showed that eyes wearing tinted lenses with surface pigments were more prone to inflammation of the ocular surface compared with those wearing clear lenses or tinted lens with embedded pigments. A previous study showed an increase in the levels of EGF and IL-8, among several cytokines, after contact lens wear.19 EGF presents in human tears and is induced in response to stimulation of the corneal epithelium, whereas IL-8 serves as a potent neutrophil chemotactic agent and an activating factor that increases in response to ocular surface inflammation. The authors of a previous study19 suggested mechanical stimulation of the corneal surface by the physical presence of contact lenses as the cause of inflammatory mediator release. Therefore, exposed pigment particles on lens surfaces can increase the surface roughness and induce mechanical irritation of the ocular surface, resulting in a greater inflammatory response. In turn, ocular surface inflammation may worsen the ocular surface status and subjective symptoms.
In conclusion, our results suggest that tinted soft contact lenses with an exposed pigment layer on the surface and increased surface roughness result in more adverse effects on the ocular surface compared with conventional clear lenses and tinted lenses with an embedded pigment layer, with more severe ocular surface inflammation and mechanical stimulation worsening the ocular surface status and subjective symptoms.
This study was partially supported by a grant (14172MFDS379) from the Ministry of Food and Drug Safety (Seoul, Republic of South Korea) in 2014 and by a faculty research grant of Yonsei University College of Medicine for 2008 (6-2008-0133).
None of the authors have any conflicts of interest to declare.
Received August 31, 2015; accepted February 2, 2016.
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