The eyelids and tear film in contact lens discomfort

Purpose: To investigate characteristics of the eyelid margins, meibomian glands and the tear film of contact lens wearers, and to determine whether these characteristics were related to symptoms of contact lens discomfort. Methods: A cross sectional study was performed on thirty existing daily wear soft contact lens wearers (6 male; 24 female) with median age of 23 years (range 18–41). Eyelid signs and tear film characteristics were evaluated during a single visit and subjects completed the contact lens and dry eye questionnaire (CLDEQ-8) to evaluate ocular discomfort. Results: Based on the CLDEQ-8 responses, subjects were classified as symptomatic (n = 17) or asymptomatic (n = 13). Grades of foam at meibomian gland orifices (3 ± 1), expressibility (2 ± 1) and quality of secretions (2 ± 1), tear evaporation rate with (112 ± 54 g/m²/h) or without (88 ± 45 g/m²/h) contact lens wear, fluorescein tear breakup time (8 ± 2 seconds) and tear lipid layer thickness (45 ± 17 nm) were significantly associated with symptoms of discomfort in symptomatic lens wearers only (r² > 0.45; p value < 0.05). Upper lid-wiper epitheliopathy, meibomian gland acini reflectivity and tear meniscus height showed significant correlations with comfort scores in both symptomatic and asymptomatic contact lens wearers (p < 0.05). A greater number of Demodex mites was also observed in the upper eyelid of symptomatic lens wearers (2 ± 1) compared to asymptomatic lens wearers (0 ± 0; p value = 0.042). Conclusions: Morphological irregularities of the meibomian glands and alterations to tear film secretions that affect tear evaporative dynamics were associated with symptoms of discomfort amongst the symptomatic lens wearers.