Contact lens intolerance

Describes a symptomatic situation, not a diagnosis. Commonly encountered though no strict definition. The Tear Film and Ocular Surface Society Workshop of 2013 put forward that this discomfort was:

“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.”

Two broad groups to consider (primary and secondary), but may be multifactorial. Different stages range from: mild struggle, reduced wear time, temporary break, to permanent abandonment.

Management requires detailed history & examination. Start with the views of your contact lens practitioner. Follow-up with further opinion and advice of an ophthalmologist if necessary.

Caution is required when dealing with a patient with contact lens intolerance (CLI). Know that spectacles are the safest solution. The causes of secondary CLI may be factors that are relative contraindications when it comes to laser vision correction (LVC) procedures.

​

Primary: contact lens related issues
1. Poor fit, defect or deposits - requires exam with contact lens on eye
2. Over wear - document daily wear time, days per week
3. Protein hypersensitivity in monthly disposables - requires upper lid eversion
4. Giant papillary conjunctivitis - mechanical edge effects - requires upper lid eversion
5. Adverse environment eg aircon, blowers, excess VDU - history
6. Sensitivity to lens design, material or solutions - requires discussion with optician

​

Ultimate test: expect complete resolution of CLI with cessation of wear
Possibly reversible: with regime modification may be able to become tolerant again
Potentially a candidate for LVC, standard risks would apply

​

Secondary: ocular surface issues
1. Dry eye
2. Blepharitis
3. Allergy

4. Nocturnal lagophthalmos

​

Ultimate Test: expect partial or no improvement in discomfort sensations with CL cessation 
Possibly reversible: chronic eye diseases may need intensive and/or specific therapy
Potentially / probably poor candidate for LVC, expect warning of higher risks