Contact Lens Surface Wettability and Demodex
Stephanie L. Woo OD FAAO FSLS
A 64-year-old white female presented to the office complaining of foggy, hazy vision for the past month. Her past history included gas permeable lens wear for 40 years; she was recently re-fit into scleral lenses due to dry eye symptoms about 2 years prior. She was a successful scleral lens wearer and was able to wear her lenses about 15 hours per day.
Upon examination, her entering acuities in each eye were 20/50 in the right eye and 20/40 in the left eye. Six months prior, her visual acuities through her scleral lenses were 20/25 in the right eye and 20/25 in the left eye. No over-refraction helped improve acuity in either eye.
Slit lamp examination revealed flakes on both eyelids with Demodex (fig 1). The eyelids were oily, with some mild frothing at the lid margin. The contact lens surfaces were oily, and the lenses were not wetting well (Fig 2). There was no debris in the tear chamber, and with both lenses removed, there was no corneal staining. At this time, we decided to treat the ocular surface with a tea tree oil formulation to remove the Demodex, along with an antibiotic eye drop and some artificial tears. We also treated the contact lens surface with a heavy cleaner to remove the lipid and protein deposits.
The patient returned 2 weeks later stating that her vision was excellent and her eyelids felt much better. Her vision was 20/30 in each eye at this visit. Slit lamp exam showed no Demodex, and the lashes were clean. There were no surface wettability issues of either contact lens. She discontinued the antibiotic drop, but continued the artificial tears twice per day and the tea tree oil treatment 3 times per week.
The patient returned for a 3-month follow up with no complaints. Her vision was 20/25 in the right eye and 20/30+ in the left eye. Her lashes were clear, and the contact lens surface of both eyes showed no wettability issues.
If a patient’s contact lenses will not wet well or exhibit an oily surface, consider lid treatment as one of the first options of care. Even with heavy duty gas permeable lens cleaners, lens wettability problems may still manifest if lid problems remain unresolved. If lid hygiene is addressed and treated quickly, this could lead to a fast improvement, yielding better patient comfort and clear vision.
Dr. Stephanie L. Woo graduated from the Southern California College of Optometry and completed a Cornea/Contact Lens residency at the University of Missouri - St. Louis.
She is a Fellow of the American Academy of Optometry and a Fellow of the Scleral Lens Education Society.
She is a contributing author for the American Optometric Association Contact Lens and Cornea section, and she is the author of the "GP Expert" column for Review of Contact Lenses.
She is also the Public Education Chair for the Scleral Lens Education society and is an Advisory Board member for GPLI. She currently practices at Havasu Eye Center in Lake Havasu, AZ.