Ask the Doctors

Thursday, September 11, 2008

Q What guidelines should I follow regarding contacts if I have ocular rosacea?

Response by Dr. Marian Macsai, vice chairman of ophthalmology at Northwestern University:

The first step is to seek the care of an eye specialist who is familiar with ocular rosacea. Successful contact lens wear depends on a healthy eye surface, and your eye doctor (ophthalmologist) can ensure that you do not have any inflammation present, that your eyelid glands are functioning normally and that you have an adequate tear supply. If any symptoms of ocular rosacea are present, your eye doctor should take steps to bring the symptoms under control before fitting you with contact lenses.

Both gas permeable and soft contact lenses are options for rosacea patients, though there are advantages and disadvantages to both. The smaller size of gas permeable lenses allows for greater tear exchange and debris removal, but the harder lens may be more traumatic to the surface of the eye. Soft lenses, while more comfortable for many people, tend to "steal" fluid from eye, potentially leading to inflammation. Loosely fitting, soft lenses with low water content may help to prevent this problem. I also recommend frequent replacement of soft lenses to reduce protein and oil buildup on the surface of the lens.

Regardless of the type of lens chosen, artificial tears can extend the wearing time for rosacea sufferers, particularly older patients who have dry eyes. Even so, some patients may only be able to wear their contact lenses for a limited amount of time.

Contact lens solution also plays an important role in a rosacea patient’s ability to successfully wear contacts. It is imperative to keep the surface of the lens as clean as possible, and I typically recommend a hydrogen peroxide-based cleansing system for soft contact lens wearers. In addition, you should discuss a hygiene routine with your eye doctor to keep the eyelid glands clear of debris and functioning normally to ensure a successful experience with contacts.

Close monitoring of your corneal surface by your eye doctor before and after lens fitting is strongly advised to be sure that the lenses are not damaging the corneal surface in any way. If at any time your eye becomes red or painful, you should immediately remove the lens and consult your eye doctor before inserting the same lens. Never wear your lenses longer than recommended and be certain to keep them clean and follow the hygiene recommendations made by your doctor and the lens manufacturer.