The clear tissue that covers the white part of the eye as well as the inside of the eyelids is known as the conjunctiva. The functions of this tissue are to provide protection against invading bacteria and also produce the mucous layer of the tear film on the eye. The conjunctiva also allows the eye to move without damaging the soft tissue of the lids.
It is vital to examine the health of the conjunctiva when a patient is considering contact lens wear, as the contact can be a source of irritation if not fit properly, or if the patient overwears the lens. There are a variety of conditions that can affect the conjunctiva in different ways and should be considered prior to being fit in soft contacts.
Giant papillary conjunctivitis (GPC) is probably the most common condition observed in soft contact lens patients. The conjunctiva becomes inflamed, but not infected, when exposed to a chronic mechanical irritant such as a soft contact lens or a suture in the eye. Irritation worsens with constant blinking throughout the day. Other sources of irritation in this condition include scleral buckles used to repair retinal detachments or corneal scars.
The inflammation caused by GPC results in large bumps known as papillae to form on the inside of the lids. This process represents a hypersensitivity reaction to a foreign object (i.e. the contact lens). Mucous begins to accumulate with the formation of the papillae, and as they grow larger, they can even displace the contact lens.
Discontinuing contact lens wear (temporarily or permanently) is the first step toward resolution of GPC. Changing to a preservative –free cleaning system, along with cold compresses and artificial tears is also helpful in alleviating symptoms of discomfort. Steroid eye drops are effective at eliminating inflammation in this situation, but should be used with caution as they can impair healing, increase the pressure in the eye, and hasten cataract growth. Antihistamine eye drops are probably a better alternative when trying to get ahead of the condition and improve comfort.
Conjunctivochalasis is a very long word to describe the loosening of the conjunctival tissue on the surface of the eye. It is normal with age for all the tissues of the body to lose their elasticity. Patients will usually notice a wrinkling of the clear tissue along the top of the lower lid and may complain of a foreign body sensation. Other symptoms include dryness, pain, and tearing.
While age is certainly a factor in the development of conjunctivochalasis, trauma, inflammation, and dry eye disease can also contribute to the formation of this condition. It is believed that contact lens use can aggravate this condition, especially with the use of rigid gas permeable lenses. The mechanical irritation over time is thought to break down elastic fibers in the conjunctiva, leading to wrinkling of the tissue on the surface of the eye.
Treatment of this condition depends on the severity of each case. Initial treatment consists of lubrication with artificial tears and/or ointments. Antihistamine drops are also helpful in cases with mild inflammation. Steroid drops may be used in more severe cases, but often have to be used for longer periods of time. Prolonged steroid use is usually discouraged due to potential side effects, as mentioned earlier. If discomfort persists, surgery can be recommended to remove the excess conjunctival tissue.
Lid wiper epitheliopathy (LWE) is a condition involving the area inside the upper and lower eyelids that rubs against the surface of the eye. The outer layer of the conjunctiva is disrupted in this condition and is believed to be the result of friction, resulting in inflammation and discomfort for the patient. The increased friction could be due to contact lens wear, dusty environments, or dry eye syndrome.
LWE is more commonly seen in contact lens wearers. The contact lens separates the mucous layer of the tear film from the other layers, leading to inadequate lubrication of the eye. Contact lens discomfort is a common complaint in this condition.
Lubrication of the eye’s surface is vital in managing LWE. Artificial gel tears help to decrease friction and improve comfort. Additional treatments include plugging the openings in the nasal corners of the eyelids to try to keep the tear film on the surface of the eye longer. Adding lubricating ointments at night is also very effective in improving discomfort.
It is necessary for your eye doctor to carefully evaluate the health of the conjunctiva at each exam, but particularly when fitting for contacts. These lenses can cause significant irritation in specific situations. It is also important for you, as a patient, to understand the steps to take to ensure a successful experience with contact lenses.