Contact lens discomfort, along with contact lens dropout, are highly prevalent conditions.1-7 The complete discontinuation of contact lenses is referred to as contact lens dropout. Contact lens dropout remains around 15-20%, even with advanced contact lens materials.

A recent study investigated characteristics of the eyelid margins, meibomian glands and the tear film of contact lens wearers to determine if the characteristics were related to symptoms of contact lens discomfort.8 Thirty existing daily wear soft contact lens wearers, 6 male, 24 female, with a median age of 23 years (range 18-41) were enrolled in the study.

Tear film characteristics and eyelid signs were evaluated. The contact lens and dry eye questionnaire (CLDEQ-8) was completed during a single visit to evaluate ocular discomfort.

According to CLDEQ-8 responses, patients were graded as symptomatic (n = 17) or asymptomatic (n = 13). The following were significantly associated with symptoms of discomfort in symptomatic wearers only.

  • Grades of foam at meibomian gland orifices
  • Expressibility
  • Quality of secretions
  • Tear evaporation rate with or without contact lens wear
  • TBUT
  • Tear lipid layer thickness

There were significant correlations with comfort scores in both symptomatic and asymptomatic contact lens wearers.

  • Upper eyelid wiper epitheliopathy
  • Meibomian gland acini reflectivity
  • Tear meniscus height

A different study evaluated the relationship of lid wiper epitheliopathy to ocular surface signs and symptoms.9 In this study of 287 subjects, dry eye and ocular discomfort questionnaires were completed and objective findings were evaluated. Only lid wiper epitheliopathy width was associated with greater symptoms in contact lens wearers. Lid wiper epitheliopathy was associated with decreased tear-film stability, contact lens wear, lid anatomy, and lid-parallel conjunctival folds.

Of interest, according to the eyelids and tear film in contact lens discomfort study, there were more Demodex mites in the upper eyelid of symptomatic lens wearers compared to asymptomatic lens wearers.8

Thus, discomfort symptoms in symptomatic contact lens wearers were associated with morphological irregularities of the meibomian glands and alterations to tear film secretions that affect tear evaporative dynamics.

Clinically, this highlights the importance of evaluating the ocular surface in contact lens wearers.


1. Schlanger J. A study of contact lens failure. J Am Optom Assoc. 1993;64(3):220-224.

2. Weed K, Fonn D, Potvin R. Discontinuation of contact lens wear. Optom Vis Sci. 1993;70(12s):140.

3. Pritchard N, Fonn D, Brazeau D. Discontinuation of contact lens wear: A survey. ICLC. 1999;26:157-162.

4. Young G, Veys J, Pritchard N, Coleman S. A multi-centre study of lapsed contact lens wearers. Ophthalmic Physiol Opt. Nov 2002;22(6):516-527.

5. Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. Feb 2007;26(2):168-174.

6. Rumpakis J. New Data on Contact Lens Dropouts: An International Perspective. Review Optom. 2010;147(11):37-42.

7. Dumbleton K, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens. Jan 2013;39(1):92-98.

8. Siddireddy JS, Vijay AK, Tan J, et al. The eyelids and tear film in contact lens discomfort. Cont Lens Anterior Eye. 2018 Apr;41(2):144-153. doi: 10.1016/j.clae.2017.10.004. Epub 2017 Oct 18.

9. Li W, Yeh TN, Leung T, et al. The Relationship of Lid Wiper Epitheliopathy to Ocular Surface Signs and Symptoms. Invest Ophthalmol Vis Sci. 2018 Apr 1;59(5):1878-1887. doi: 10.1167/iovs.1723639.