Contact lenses and your eyes By Prinze C. Mack, M.D. Contact lenses, when used properly, can provide excellent vision and convenience for patients with refractive errors. Whether you are nearsighted, farsighted, or have an astigmatism, contact lenses can make most of your work or school day glasses-free. In addition, patients who are presbyopic (in need of reading glasses, usually over the age of 45) can benefit from a monovision contact lens fitting, where one eye is set as the reading eye, and the other is the distance eye, thereby eliminating the need for reading glasses. However, contact lenses are often misused and/or continued to be used by individuals with underlying eye disease. For instance, patients often sleep in their contact lenses, a practice that is extremely unhealthy and can lead to disastrous infections of the cornea. Those patients who have been sleeping in their lenses need to see an ophthalmologist immediately for evaluation. Disorders such as blepharitis, dry eye syndrome, and allergic conjunctivitis can make contact lens use uncomfortable, or even unbearable. All contact lens patients need routine evaluations by an ophthalmologist to find and treat such conditions, and patients who are already suffering from discomfort with contact lenses need to be seen as soon as possible. Blepharitis is a condition where the eyelids are inflamed due to over-colonization of bacteria such as staphylococcus. While not an infection per se, the overgrowth of bacteria tends to inflame the eyelids, causing generalized discomfort of the eyes, especially with contact lenses; however, the bacteria also change the composition of the tear film by altering the lipid secretion from the eyelid.This will lead to increased tear evaporation, therefore leading to dry eyes. Lid hygiene and antibiotics will help manage blepharitis. Dry eye syndrome, as referenced above, goes hand in hand with blepharitis. While alterations in the tear film lead to dry eyes due to increased evaporation, dry eye syndrome may also manifest by a relative undersecretion of tears. Logically, without enough "liquid" on the surface of the eye and contact lens, the eye will become dry and uncomfortable. This syndrome will feel like sand is in one's eye, and one's vision actually may be blurry until blinking or refocusing. While dry eyes most often occurs without a specific cause, it can also be secondary to disease syndromes such as systemic lupus erythematosus, Sjogren's syndrome, and other autoimmune diseases, all of which should be ruled out by a doctor. Dry eyes can usually be treated effectively with replacement tear drops, but sometimes medical treatment with punctual occlusion (a reversible procedure that stops most of the tear drainage from the eye) will help by increasing the available tear reservoir. Allergic conjunctivitis can occur due to environmental allergens, but also can occur as a reaction to contact lenses or their deposits. A special form of allergic conjunctivitis, known as GPC, can occur either due to mechanical rubbing of the contact lens on the inner eyelid, a reaction to the lens material, or a reaction to protein deposit buildup on the lens. Oftentimes, a temporary discontinuation of contact lens, a thorough cleaning of the contact lenses, and treatment with prescription anti-histamine combination eye drops will alleviate this condition within a few weeks. If you are experiencing difficulty with wearing contact lenses, an evaluation by your local ophthalmologist is necessary to diagnose and treat these conditions. In addition to medical treatment, your ophthalmologist may recommend changing to a new brand or type of contact lens. Currently, two-week disposable lenses are excellent choices for patients, and some companies are offering one-day contact lenses that most patients enjoy. Your ophthalmologist will inform you of the best choice to make your contact lens experience most comfortable and safe. Dr. Prinze Mack is in practice at Freehold Ophthalmology. Freehold Ophthalmology has three locations: Freehold, (732) 431-9333; Toms River, (732) 349-7167; and Brick, (732) 458- 5700.