Bandage Contact Lens for Dry Eye Everyone has heard of contact lenses to correct vision, but perhaps less familiar is their role as a medical treatment. “Bandage contact lenses” (BCL) are a valuable option for treating ocular surface conditions and other corneal diseases. Using a protective barrier for help healing of a skin wound is second nature – grab a band-aid! A bandage protects the open area while it heals naturally and prevents further trauma from slowing the regrowth of our skin. Bandage contact lenses are not unlike a band-aid for the cornea. PROTECTION A primary reason to use a BCL is to protect the cornea from friction created by the rubbing action of the eyelids that travel over the corneal surface 10-20 times each minute (blinking). Structural eyelid abnormalities (e.g. misdirected eyelashes or inward rotated lid margin) or exposed sutures can tear the corneal surface. Prior to structural repair, a BCL provides temporary protection of the corneal surface from being scratched or torn. Some patients have hereditary conditions or prior traumatic injuries that make the corneal surface or epithelium more prone to tear, leading to recurrent erosions. If medical treatment (hypertonic saline drops and/or ointment) is ineffective, BCL may be used until the surface has healed and stabilized.
PAIN RELIEF Corneal abrasions, erosions, filaments or edema can cause intense pain. Alongside other required medications, a BCL often provides rapid relief from pain for patients who experience these conditions.
HEALING There are many conditions that results in a need to encourage epithelial repair, including dry eye, corneal abrasions, recurrent erosions, chemical injuries, and post-surgical problems following vision correction or corneal transplant procedures. Neurotrophic keratitis, a condition where corneal nerves do not function properly, is very challenging to manage and often requires BCL treatment.
COMPLICATIONS BCL need to be properly fit and properly monitored. Lenses should be soft lenses with adequate delivery of oxygen to the corneal surface and approved for extended wear. A too-tight fitting lens may cause pain and swelling to develop, so the first few hours after BCL fitting are very important. In some cases, a custom fit BCL is needed for patients with unusually shaped corneas. Extended wear of any contact lenses is associated with a risk of infection, so even though a BCL can be worn for weeks to several months, replacing the lens every 2 weeks is advised. SCLERAL CONTACT LENSES USED AS A BCL Scleral lenses are large-diameter rigid lenses. They vault over the cornea and rest on the conjunctiva and sclera. Because there is a reservoir of liquid behind the lens and the lens does not directly touch the cornea, scleral lenses are extremely beneficial for corneal wound healing. The rigid structure also ensures maximum vision correction for patients with irregular corneas. For patients who require a long-term bandage lens, scleral lenses can greatly improve quality of life. In the hands of trained physicians, bandage contact lenses are a versatile tool to protect the cornea, relieve pain and facilitate healing. #dryeyedisease#taubereyecenter#taubereyeresearch#tauberteachings... See MoreSee Less
Dry Eyes? Ocular Surface Disease? Aqueous Deficiency? Evaporative Dry Eye? Tear Dysfunction? Neurotrophic Eye Pain? Blepharitis? Meibomian Gland Dysfunction? Meibomitis? Inflammatory Dry Eye? Dry Eye Flare? Are these distinctions with a difference or just many terms for a single problem? After all, all types of cats ARE animals, no?
In trying to teach clinician skills, I often paraphrase an idea (that has echoed over centuries) that says: once you label a thing, you no longer have your eyes open to see what it actually is. Perhaps better phrased by Philip Pullman (author, The Amber Spyglass), “People are too complicated to have simple labels.” I am not certain which is the better way to look at dry eye. Should we think of this condition as many different abnormalities that each or in combination cause an unhealthy or dysfunctional tear film? That is certainly where an earlier DEWS definition of dry eye landed. Or should we remain mindful of each specific pathogenic process so that we address each adequately to control both symptoms and signs?
In my personal practice, I’ve combined both outlooks, giving recognition to the specific processes that need correction and also to the overall impact on the ocular surface. I treat anterior blepharitis (crusts, Staphylococcus, Seborrhea, Demodex) differently than I treat posterior blepharitis (MGD, duct occlusion, inflammation). I treat aqueous tear deficiency differently than I treat “lipid deficiency’ / evaporative dry eye. Treatments for inflammation (present in varied degrees in most patients) and for neurotrophic abnormalities are specifically used when those abnormalities are present. We must always remember that we treat our patients, not only their ocular surfaces. Patients need to have their complaints heard, appreciated and addressed. Sometimes or often, we must bring abnormalities to their attention even when they are unaware of an abnormality that causes them to compliant, or just to function sub-optimally. Being a dry eye specialist is quite demanding, with the need to dissect this complex collection of abnormalities that combine to disrupt the normal homeostasis of the tear film, establish an understanding of what must be corrected, and then communicate all this to our patients, who generally have little desire to hear all the details. Providers who hand their patients a collection of artificial tears with the instruction to “use the ones you like the best” are unlikely to succeed. Me? I love this challenge. And yes, I am a micro-splitter. I diagnose down to subcategories, in my head. But in my words, I remain focused on treating the broader ocular surface, the whole eye and the whole patient. #tauberteachings#taubereyecenter#dryeyedisease#taubereyeresearch... See MoreSee Less
Dry Eye: Cure vs. Control Let’s start with a bitter truth. Physicians don’t cure many diseases, though we have effective strategies and interventions to control many. There are exceptions, of course. When an infectious organism is killed by an antibiotic, we are cured of that infection (not as true for viral or other infections though). If one develops high blood pressure and a pill succeeds in controlling it, we expect that we will continue the pills to maintain a healthy pressure. Asthma? Inhalers and other medications improve symptoms, and environmental measures help a lot, but we don’t really cure that. Angina? Arthritis? Heart failure? Diabetes? Controlled, but not cured. This bitter pill seems very natural to swallow when we think of diseases that affect our bodies. But when it comes to our eyes, I see many patients rebel against the idea that long term treatment is needed to control diseases, both those with symptoms (like dry eye) or less overtly symptomatic conditions like glaucoma, the “sneak thief of sight”.
Managing expectations is an important aspect of medical care, as is engaging patients in their own care. When patients have unrealistic expectations of cure that go unrealized, they may disengage from their caregivers in search of “the magic bullet” for their ails. In my own practice with dry eye patients, I always touch on the issue of control versus cure before detailing a treatment plan. Sometimes I mention “grandmother wisdom” that tells us “it will take about as long to get rid of a problem as it took for it to come on in the first place” - my attempt to make this perspective one that everyone can relate to.
Really communicating with patients is my favorite part of my job. I actually enjoy translating into simple language the complicated science of what causes the various types of dry eye. Explaining that most patients have combinations of excessive tear evaporation, reduced tear production, inflammation, nerve dysfunction and inflammatory, and thick eyelid oils is a lot to accomplish in the minutes we have with each patient, but it must be done. Add to this: 1. the need to get patients to buy into the (typically multi-pronged) treatment strategy and 2. understanding that improvement will take time and 3. will require chronic therapy (of various types) – and one can understand the challenges a dry eye specialist faces every day. The communication with our patients is likely more challenging for many than actually making a diagnosis. For me, the foundation of effective medical care in dry eye, and perhaps in all of medicine, includes: • Listening, • Examining, • Diagnosing, • Explaining and Answering Questions • Ensuring Understanding, • Managing Expectations, • Compliance • Follow Up. I love my job, being a clinician, and often it is the personal connections we build that are the most gratifying. #tauberteachings#dryeyedisease#taubereyecenter#taubereyeresearch... See MoreSee Less
Dry eyes and ocular allergies are among the most frequent reasons patients go to an eye doctor. Though these are different medical conditions, with different triggers, different disease processes and different treatments, both conditions can be present and active at the same time. Also challenging is the similarity in patient symptoms and also in treatments likely to be recommended. How is a patient to know which it is? Basic facts (simplified): dry eyes are due to reduced tear production, abnormal tear quality (including rapid evaporation), inflammation on the ocular surface and abnormalities in nerve activity, both on the eye surface and centrally (within the brain). Allergic diseases (that vary considerably in severity from seasonal to year-round environmental allergies to more serious conditions called Vernal or Atopic disease) can be generally thought of as an abnormal body response to “allergens” – indoor or outdoor irritants, chemicals, germs, etc. – that creates inflammation. Allergic inflammation generally creates redness, swelling (around and beneath the eyes), tearing / watering and itching. Both allergies and dry eye can cause light sensitivity, redness, a foreign-body sensation, blurred vision and grittiness. Mucus or discharge may be present in both conditions. Eye rubbing can cause redness and tearing to worsen. Though nothing is absolute, as many as 90% of patients with itching turn out to have allergic disease, but eyelid oil abnormalities also cause itching and lid redness, creating diagnostic confusion. The presence of nasal stuffiness or non-ocular allergy symptoms can be informative too. Seasonal recurrence of symptoms is obviously helpful in identifying allergies. If itching is absent, it is unlikely that allergy is the cause of symptoms. Some physical findings help eye doctors separate these conditions, including the presence of small bumps on the undersides of the eyelids and some tear antibody tests, but it is difficult for patients to accurately self diagnose. In treating these conditions, artificial lubricants help both – either by supplementing tears for a dry eye patient or by washing away offending allergens in allergic patients. Anti-inflammatory eye drops (e.g. steroids) help both. Patients often try oral antihistamines at home, good for treating allergy, but which reduce tear production and may worsen dry eyes. For allergy, it is safer and often more effective to treat the process of allergy specifically, with antihistamine or mast cell stabilizing eyedrops, available over-the-counter and by prescription. As with many medical problems, an accurate diagnosis leads to accurate treatment, so seeing an eye doctor is often better than self-treatment. #dryeyedisease#taubereyecenter#tauberteachings... See MoreSee Less