Contact Lenses and Sensitive Eyes

What Is a Sensitive Eye?

A sensitive eye is, simply enough, an eye that becomes bloodshot, teary, or uncomfortable under circumstances that don't bother other eyes. A smoke-filled room, dry air, a gust of wind, chemical or cosmetic fumes--all these can irritate a sensitive eye. Not necessarily diseased, a sensitive eye simply overreacts to certain irritants.

Why Are Some Eyes Sensitive?

A number of different factors can produce a sensitive eye. Common causes include: seborrheic blepharitis (irritation of the eyelids), dry eye, abnormalities of the eyelid or the surface of the eye, use of eye cosmetics, and allergy. In the healthy eye, a thin layer of tears covers the eyeball at all times, keeping it lubricated and allowing the eyelid to slide smoothly over the eye during blinking. Blinking, in turn, helps to keep the tear layer smooth and even, and the eye moist. People with seborrheic blepharitis often have a normal amount of tear fluid, but their tears are excessively oily. Because of this oiliness the surface of the eye does not wet properly, and a burning, scratchy, dry feeling may result-a condition that feels like a true dry eye. Many people with seborrheic blepharitis also have poor lid function and don't blink properly. This promotes additional drying of the eye's surface and increases the irritated feeling. In true dry eyes, the problem once again is poor lubrication of the eye's surface. Dry eye may be the result of too little tear fluid; but more often dry eye results from tears that are adequate in volume but chemically unbalanced, so that the surface of the eye does not wet evenly. When, for whatever reason, the surface of the eye becomes dry, the situation is like a poorly oiled machine-surface friction that leads to irritation, producing symptoms of burning, scratching, and foreign body sensation. Conditions that produce abnormalities of the surface of the eye impair wetting of the eye during blinking. Cysts and small benign growths on the surface of the eye (such as pinguecula and pterygia) tend to become irritated on their surfaces, producing local symptoms of burning, dryness and sensitivity.

Although irritation from cosmetics is often blamed on allergy (which accounts for the large number of "hypoallergenic" cosmetics available), the fact is that eye cosmetics may simply be irritating. The long-term use of cosmetics around the eyes tends to produce a state of chronic irritation which can make the eye overly sensitive. In addition, very old or improperly stored cosmetics--especially mascara and eyeliner--can become contaminated with germs and lead to eye infections, especially if shared by different people. Allergy certainly can produce a sensitive eye. Allergies can be seasonal (like hay fever) or year-round, and one can be allergic to a single substance or to many. Allergies produce watering, itching, redness, and irritation in the eyes. When allergy is present, the eyes may be so sensitive that they react to other substances that the sufferer is not allergic to. Allergy or reaction to contact lens care solutions themselves may occur. If so, it may be necessary to switch to another care system on the advice of your practitioner.

Can Contact Lenses Affect a Sensitive Eye?

Yes. Since contact lenses are foreign bodies they can act like other irritants and make a sensitive eye act up. All eyes are somewhat sensitive to contact lenses-after all, the contact lens is not a normal part of the eye. But a sensitive eye has less ability to adjust to the presence of a contact lens.

Can Patients with Sensitive Eyes Wear Contact Lenses?

Patients with sensitive eyes can wear contact lenses, the question is how well? Many people with sensitive eyes wear contact lenses without serious threat to the health of their eyes. But they may experience some degree of discomfort. Their symptoms may include lens awareness, foreign body sensation, and a scratchy, dry feeling. Their eyes may become red and bloodshot, a visible sign of irritation. Patients with sensitive eyes often don't tolerate lens wear for as many hours consecutively as those with normal eyes; and people with sensitive eyes may not be able to wear their lenses every day. Depending on the reason for the sensitivity, some people with sensitive eyes may be advised to avoid wearing certain kinds of lenses. And people with sensitive eyes may be limited in their selection of contact lens care products.

Who Can Diagnose a Sensitive Eye?

Your eye doctor. If you have sensitive eyes, you probably already know it. Occasionally though, a condition, such as a slightly dry eye or a mild inflammation of the eyelid, can exist without producing noticeable symptoms to you. In that case, your eye doctor will warn you that wearing contact lenses may bring on noticeable symptoms.

What Can Be Done?

If the condition producing the sensitivity is treatable, every effort should be made to take care of the condition before contact lens wear is begun. Treatment might include the use of lubricants for dry eyes, lid hygiene for seborrheic blepharitis, or avoidance of irritating eye cosmetics or eye medications.

What Kinds of Contact Lenses Are Used for Sensitive Eyes?

First, prolonged or extended (overnight) wear should be avoided in eyes that are easily irritated. The choice of a lens for a sensitive eye depends largely on the reason for the sensitivity. For example, high water content soft lenses are usually a poor choice for people with dry eyes. People with conditions like seborrheic blepharitis or allergy that produce a "dirty" tear film should avoid lenses that become readily coated with tear materials. Your eye care practitioner will discuss your options with you.

Are Contact Lenses Dangerous for Sensitive Eyes?

As long as the wearer knows of the problem, has been carefully fit, and makes regular visits to the eye doctor, there is very little risk of serious damage to the eye. When irritation occurs, the best rule for dealing with your contact lens is simply "when in doubt, take it out." Then be sure to contact your eye care practitioner.

The above information is taken from the CLAO Patient Information Pamphlet titled CONTACT LENSES AND SENSITIVE EYES. Pamphlet Advisor was Susan M. Stenson, MD. Copyright 1997-2004, Contact Lens Association of Ophthalmologists, Inc.