Why do contact lenses cause dry eye symptoms?
Contact lenses sit on the tear film, the thin layer of liquid that keeps the eye's surface healthy and smooth. The lens absorbs some of the tear film and can disrupt its stability, leading to faster evaporation. Standard soft lenses also cover the limbus (the junction between the cornea and the white of the eye), which is where many of the nerves responsible for stimulating tear production are located. The result is that wearing lenses can reduce the stimulus for adequate tear production.
Which contact lenses are best for dry eyes?
Not all lenses are equal for dry eye patients. Several factors matter:
Daily disposables
Fresh lenses every day means no buildup of protein and lipid deposits that degrade lens wettability. Daily lenses are significantly more comfortable for dry eye patients than monthly lenses worn repeatedly.
High water content vs silicone hydrogel
Counterintuitively, high water content lenses can be worse for dry eyes because they maintain their hydration by drawing moisture from the tear film. Silicone hydrogel materials allow more oxygen through and tend to remain more stable on a compromised tear film.
Preservative-free lubricating drops
Rewetting drops compatible with your lens material can significantly extend comfortable wearing time. Drops containing preservatives should be avoided with contact lenses, use only preservative-free formulations.
What about scleral lenses for dry eye?
For patients with moderate to severe dry eye, including those with Sjögren's syndrome, graft-versus-host disease, or post-LASIK dry eye, scleral lenses are transformative. The fluid-filled reservoir between the back of the lens and the corneal surface provides continuous hydration throughout the day. Many patients who cannot tolerate any standard lens for more than a few hours wear scleral lenses comfortably for 12–14 hours. Scleral lenses are now considered a front-line treatment for severe dry eye by corneal specialists worldwide.
Can dry eye be treated while continuing to wear lenses?
Yes. The approach is to manage the underlying dry eye condition in parallel with optimising the lens choice. This may include warm compresses and lid hygiene to improve meibomian gland function (the glands that produce the oily layer of the tear film), preservative-free artificial tears used regularly, and in some cases omega-3 supplementation. For contact lens wearers specifically, a daily disposable silicone hydrogel lens with regular preservative-free lubrication is often the starting point.
When should you take a break from lenses?
If you're experiencing redness, pain, sensitivity to light, or sudden change in vision, remove your lenses immediately and see an eye care professional. These can be signs of corneal inflammation or infection, which is more common in dry eye patients because the compromised tear film provides less protection. For chronic discomfort, a lens holiday of 2–4 weeks, wearing glasses only, can allow the ocular surface to recover before trying a different lens type.
Dry eye contact lens fitting at Second Sight
We see many patients who have been told they 'can't wear contact lenses' because of dry eye. Our approach is to assess the tear film in detail, understand what type of dry eye is present, and match it to the most appropriate lens option, from daily silicone hydrogel lenses for mild cases to scleral lenses for severe or treatment-resistant dry eye. In most cases, patients who thought lenses were behind them find an option that works.
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