Contact Lens Intolerance

Are you not able to wear contact lenses anymore? Here’s What You Need To Know.

“I loved wearing my contact lenses for years and years and now I just cannot wear them for more than a couple of hours – please help !” This was a patient I saw a few weeks ago who was experiencing sudden contact lens intolerance – desperate not to have to switch to glasses permanently. She came to see me to be considered for laser eye surgery as an alternative.

Having practiced laser eye surgery since 1990 and almost 30,000 procedures, I have seen many patients where the condition “Contact Lens Intolerance” has tipped them into seeking vision correction surgery. Experienced eye surgeons are cautious when dealing with patients who are contact lens intolerant. The very causes of intolerance may be factors that are relative contraindications when it comes to vision correction procedures.

Our goal as doctors is to ensure patients who come to see us in trust have their problems handled. Where they are contact lens intolerant, we determine and treat the cause to enable them to use contact lenses again.
Hopefully, this article will serve as a guide to becoming contact lens tolerant again.

What is contact lens intolerance or CLI ?

Commonly referred to as “Contact Lens Allergy”, Contact Lens Intolerance is a condition where a contact lens wearer experiences pain or discomfort requiring removal of the lens. It can occur at any age and is a result of a variety of reasons. It is important to have this condition addressed promptly as continued use may well result in a severe corneal infection. Consider intolerance to contact lenses a warning to avoid lenses and to be seen by an eye care professional.

Contact Lens Intolerance: What causes it?

The more common causes of Contact Lens Intolerance are allergies and dry eye and require evaluation. Allergy to contact lens solutions or protein deposition on non-disposable contact lenses can also cause irritation of the conjunctiva. The conjunctiva is the mucous lining of the eye surface which covers the white of the eye and the underside of the lid.

Poor lens care – Poor lens hygiene, overwear and not being seen regularly by the prescribing optometrist can contribute to contact lens intolerance.

Giant papillary conjunctivitis from contact lenses is a condition where small bumps form on the underside of the upper lid. The classic symptom described is “every time I blink my contact lens moves”. The cause is often protein deposition on the lens. A contact lens “holiday” along with appropriate treatment prescribed by a prescribing optometrist or ophthalmologist will help reduce the bumps and can take a couple of months. Switching over to daily disposable soft contact lenses may well avoid a recurrence.

Allergic conjunctivitis is often seasonal (Spring when the pollen is out) and results in excessive tearing, itching and eye redness. Sodium Cromoglycate eye drops (available over the counter) is a first line treatment. In severe cases steroids may be required but will need a prescription from an ophthalmologist who has evaluated the condition. Allergies to contact lens solutions can be a cause of intolerance. A simple option is to try an alternate storage solution. A trial of disposable lenses may be the easiest option going forward.

Dry eye – is a common cause of which there are a multitude of causes. The most common and one that increases in likelihood with age is evaporative dry eye as a result of meibomian gland disease. This is where oil producing glands shaped like piano keys become clogged up and stop secreting necessary oils that maintain stability of the tear film on the surface of the eye. The oils can break down into fatty acids which burn and cause inflammation and irritation after wearing contact lenses. Additionally stagnant oils serve as food for opportunistic organisms like bacteria and parasites (Demodex) which in turn can cause even more inflammation and irritation.

Dry eye can be “underproductive” whereby the lacrimal glands reduce the amount of liquid being secreted. Reduced secretion does occur in contact lens wearers because of reduced sensitivity on the eye surface. The balance of production vs. need for tears can sometimes be tipped over resulting in CLI. Contributing factors include advancing age and hormonal changes as can autoimmune conditions like Rheumatoid arthritis.

To understand the specific causes of dry eye, specific tests are conducted followed by a good clinical evaluation. Treatment advised will be based on the findings. The specific cause/s of the condition can be addressed and once resolved may well reduce the level of intolerance experienced. There are a variety of treatments for dry eye.

Infection – This can be a cause of acute / sudden onset contact lens intolerance and is accompanied by pain, sensitivity to light and a red eye. All contact lens wearers are advised (and sometimes forget) that if they develop any of these symptoms, they should be seen right away by an eye care professional. A corneal infection is a serious condition that can lead to severe problems.

Contact Lens Irritation Treatment: Relieve Your Eyes

Those affected by CLI are advised to be seen by an eye care professional like their own optometrist. Referral may be required to an ophthalmologist with expertise in the front of the eye ( a corneal specialist). Specific causes once determined can be treated and will hopefully enable those with CLI to get back into contact lenses again.

Changing the lens – Simple measures like switching to daily disposable lenses or changing the brand of lens or contact lens solution might well improve tolerance.

Artificial tears that are preservative free are a good option. They work by both improving lubrication and dilution of any toxic inflammatory substances that may be present in the natural tears.

Contact lens holiday – leaving contact lenses out for a period of a few weeks can help in regularising the ocular surface and allow a reduction in inflammation. This is useful in those who have overworn lenses and have become intolerant.

Discontinuation of Contact lenses permanently may be the only option where everything has been tried and alternatives discussed below can be considered.

Alternatives to Contact lenses

When all measures fail and contact lenses cannot be worn, vision correction surgery is a consideration.
Options include laser eye surgery , implantable contact lenses or in those who are older lens replacement surgery. It is best to be evaluated by an expert ophthalmologist experienced in these types of procedures and knowledgeable about dry eye and the ocular surface.

Contact lens intolerance is not an uncommon condition and probably happens to a good portion of wearers. Prevention through proper use of contact lenses along with good hygiene and avoidance of excessive wear times are worthy of consideration. When intolerance becomes constant, seeing an eye care professional is important to determine and treat possible causes. When all fails then surgical alternatives to permanently correct vision can be a consideration.

Authored by Sheraz Daya MD FACP FACS FRCS(Ed) FRCOphth, Consultant Ophthalmic Surgeon & Medical Director, February 2023.