Contact Lens-Induced Dry Eye (CLIDE) is a common condition affecting many lens wearers. Understanding its causes and symptoms can help improve your eye health.
Contact Lens-Induced Dry Eye (CLIDE) is a condition where the natural tear film becomes compromised by the presence of a contact lens, causing discomfort, irritation, and a host of unpleasant symptoms. It is important to understand that CLIDE is not simply a minor inconvenience, but a condition that can significantly affect your visual comfort and overall eye health. As many as 30 to 50 percent of contact lens users experience CLIDE, making it one of the most common challenges faced by those who choose contact lenses for vision correction.
The root cause of CLIDE is primarily the friction that develops between the contact lens and the ocular surface. When you wear contact lenses, they create a barrier that separates the natural tear film into two parts: a pre-lens film and a post-lens film. This important separation can lead to several alterations in tear film dynamics. Here’s the thing: the tear film naturally provides lubrication, nourishment, and protection to the eye, but when its uniformity is disrupted, it tends to thin out more quickly and evaporate faster.
In a healthy eye, the tear film is composed of multiple layers—a lipid layer on the outside to prevent evaporation, an aqueous layer to provide moisture, and a mucin layer to help the film stick to the surface of the eye. When a contact lens is introduced, it splits this natural layering process into a pre-lens tear film (on top of the lens) and a post-lens tear film (between the lens and the cornea). This splitting not only thins the tear film but also increases friction during every blink. The result is a disruption in the smooth distribution of tears, leading to dryness and discomfort.
Contact lenses are manufactured from various materials, each with different properties such as moisture retention and oxygen transmission. Lenses with high water content may paradoxically draw moisture from your eye instead of retaining it, exacerbating dry eye symptoms. On the other hand, new advancements in lens technology focus on enhancing moisture retention by altering the surface properties of the lens. Some of the modern designs include water gradient technologies and self-moisturizing materials that attract and bind water to the lens surface, thereby minimizing the rapid evaporation of tears.
Over time, contact lenses can accumulate deposits such as proteins and lipids from natural tears. These deposits interfere with the smooth flow of the tear film and further aggravate the dryness. Even a mild level of deposits on the lens surface can disturb the balance of your tear film, causing it to break up more quickly. This phenomenon is often compounded by factors like environmental conditions, where pollution and allergens may trigger a heightened inflammatory response, leading to a condition sometimes even referred to as dysfunctional tear syndrome.
The meibomian glands, located along your eyelids, are responsible for secreting oils that form the outermost layer of the tear film to reduce evaporation. Research indicates that contact lens wearers often experience a higher rate of meibomian gland dropout compared with non–lens wearers. This means that less oil is available to stabilize the tear film, and consequently, the eyes become more prone to rapid tear evaporation and dryness. In addition, people who use digital screens for extended periods may blink less frequently, further impairing the protective role these glands normally serve.
It is important to be able to identify the signs and symptoms of CLIDE so you can seek appropriate treatment. Many patients notice issues that progressively worsen as they spend more time wearing their lenses or as the day evolves.
These symptoms generally arise because the tear film that normally coats and protects the ocular surface is destabilized, leading to an irregular optical surface and, ultimately, discomfort and visual disturbances.
Don't let discomfort hold you back. Schedule an eye exam today to learn about managing CLIDE and find a top optometrist near you.
For our eye doctors, making an accurate diagnosis of CLIDE starts with a detailed patient history and an examination of the tear film. It isn’t as simple as merely observing dry eyes; understanding the dynamics of the tear film is key.
During an eye examination, several tests are routinely used to assess the condition of the tear film:
These tests help our eye doctors pinpoint the severity of the condition, which in turn guides the tailored treatment approach needed to address your CLIDE symptoms.
Managing CLIDE involves both symptomatic relief and long-term strategies to improve the overall tear film stability. The goal is to reduce friction, improve tear retention, and create a more comfortable contact lens wearing experience.
Here’s the thing: although many current treatments provide temporary relief, a combination of therapies is often necessary for lasting comfort. Let’s explore some of these management options in detail.
Artificial tears are the first line of defense against the discomfort of CLIDE. These over-the-counter lubricating solutions help to temporarily restore moisture on the ocular surface. It is recommended to use preservative-free options when possible, as they are gentler on the eye with frequent use. These drops work by supplementing your natural tears, thereby decreasing friction and cushioning the contact lens against the corneal surface.
Many contact lens manufacturers have developed lenses specifically designed to improve moisture retention. For example, brands offering lenses with water gradient designs and moisture-sealing technology aim to maintain a more stable tear film throughout the day. Additionally, increasing the frequency of lens replacement—for instance, opting for daily disposables—helps to reduce the buildup of deposits that can exacerbate CLIDE symptoms.
Choosing the right contact lens material is crucial. In some cases, lenses that allow for higher oxygen permeability or those specially engineered to minimize friction can make a substantial difference in comfort. Our eye doctors carefully consider your lifestyle, the nature of your tear film, and any specific issues you might be facing when recommending a new lens type.
As we’ve discussed, the meibomian glands play a vital role in the stability of your tear film by secreting oils that reduce evaporation. For patients with CLIDE, maintaining these glands is essential. Warm compresses and gentle eyelid massages can help stimulate these glands, improving the quality and quantity of oil secretion.
Regular eyelid hygiene—using cleansers designed for the delicate skin around the eyes—can also remove debris and reduce inflammation, thereby improving the overall health of the ocular surface. Some patients may benefit from treatment regimens that include prescription medications, such as topical anti-inflammatories, which help manage the underlying inflammatory components of dry eye related to contact lens wear.
For more severe cases of CLIDE, additional treatment options may be needed. One such approach is the use of punctal plugs, which are tiny devices inserted into the tear drainage ducts. By blocking tear drainage, these plugs help to retain moisture on the ocular surface for a longer period.
Furthermore, there is an emerging interest in physical stimulation of the tear glands, where gentle, targeted pressure is applied to promote natural tear production. Although these treatments are typically reserved for cases where conventional therapies have not produced adequate relief, they demonstrate the innovative approaches our eye doctors consider when managing CLIDE.
One of the most exciting frontiers in managing CLIDE comes from recent research breakthroughs. A collaborative team at the Terasaki Institute for Biomedical Innovation (TIBI) has developed a prototype contact lens featuring innovative microchannels designed to facilitate tear flow. These microchannels act like tiny irrigation systems embedded within the lens. During each blink, natural eye pressure forces tears through these channels, effectively replenishing the tear film behind the lens.
This groundbreaking design includes reservoirs that store and release tears in a controlled manner, ensuring that the ocular surface remains hydrated throughout the day. While these lenses are still under rigorous testing and are not yet widely available, they represent a glimpse of the future where contact lenses may not only correct vision but also actively protect and enhance eye health.
Don't let discomfort hold you back. Schedule an eye exam today to learn about managing CLIDE and find a top optometrist near you.
Contact Lens-Induced Dry Eye (CLIDE) affects many lens wearers. Learn about causes, symptoms, and management strategies to improve your eye health.
