The human tear film is a highly ordered structure consisting of a thin layer of lipid on the surface and a thicker aqueous-mucin phase, which increases in mucin concentration toward the corneal epithelial cell layer. The health of the tear film and ocular surface influences the likelihood of being able to achieve successful contact lens wear. Contact lens discomfort and dryness are the most frequent reasons why contact lens wearers experience reduced wearing times, which can eventually lead to contact lens discontinuation. Comprehensive clinical assessment of tear film integrity and ocular surface health is therefore essential prior to commencing contact lens wear, to enable the ocular surface environment to be optimised to support lens wear. These parameters should also be evaluated over the course of contact lens wear, in order to identify any aspects requiring clinical management and ensure maintenance of optimal lens-wearing conditions. This review summarises current knowledge relating to the effects of soft contact lens wear on the tear film and ocular surface. It also provides a systematic approach to evaluating tear film and ocular surface integrity, in order to guide the clinical management of tear film anomalies with respect to contact lens wear.Key words: conjunctiva, contact lenses, cornea, dry eye, tearsThe tear film is a complex, precisely ordered fluid structure comprising a thin outer layer of lipid and a thicker underlying aqueous-mucin phase, with increasing mucin concentration toward the corneal epithelial cell layer. A thin layer of membrane-bound mucin, glycocalyx, imparts hydrophilicity to the hydrophobic corneal surface.1 In excess of 1,000 proteins or fractions of proteins have been identified within the human tear film.2,3 The tear fluid also contains a variety of regulated inflammatory mediators, including by-products of arachidonic acid metabolism, the complement cascade, cytokines and components derived from the ocular microbiome.
3,4The integrity of the tear film can strongly influence the likelihood of achieving successful contact lens wear. Contact lens discomfort and dryness are the most frequent reasons why contact lens wearers experience reduced wearing times, which can eventually lead to contact lens discontinuation. 5 Comprehensive clinical assessment of tear film quality and quantity, and ocular surface health are therefore essential both prior to commencing contact lens wear, to enable the ocular surface environment to be optimised to support lens wear, and over the course of lens wear, to identify any aspects requiring clinical attention to maintain optimal lens-wearing conditions. This review summarises current knowledge relating to the effects of soft contact lens wear on tear film composition, and outlines an approach to evaluating tear film and ocular surface integrity, to guide the clinical management of tear film anomalies with respect to contact lens wear.
ASSESSING THE TEAR FILM AND OCULAR SURFACE IN CONTACT LENS WEAR: A SYSTEMATIC APPROACHUsing techniques such as in...