Contact lens wear is associated with discomfort. This presents a real problem for wearers, practitioners and industry as discomfort is one of the main reasons for contact lens wearers to drop out of lens wear.

At the School of Optometry and Vision Science at the University of New South Wales we have recently studied whether changes to ocular microbiota are associated with discomfort during wear and whether microblepharon exfoliation of the lid margin changes the ocular microbiota and if this is associated with improved comfort.

We enrolled 30 contact lens wearers, measured their comfort during lens wear using the CLDEQ-8 questionnaire and swabbed their eyelids. The swabs were then cultured to identify and enumerate the types of microbes colonising the lids. Culture and identification used standard microbiological techniques. We then either washed their eyelids once with a foam cleanser or used the foam cleanser along with microblepharon exfoliation with BlephEx. After treatment, we gave them the CLDEQ-8 questionnaire again and swabbed their eyelids for microbial identification and enumeration. We then left the subjects for 7-10 days and repeated the CLDEQ-8 and microbial workup to assess which changes lasted for that time period.

Treating eyes with either a foam cleanser or the foam cleanser with microblepharon exfoliation improved the comfort of symptomatic lens wearers (CLDEQ-8 >12 points). By 7-10 days after treatment, with the foam cleanser alone, the scores of symptomatic wearers improved by two points on the CLDEQ-8 scale, but they remained above the cut-off of 12 and so were still classified as symptomatic. On the other hand, use of the foam cleanser with the microblepharon exfoliation improved the CLDEQ-8 scores by six points and most symptomatic wearers had scores below 12, converting them to asymptomatic wearers.

Symptomatic lens wearers were found to have approximately 50% more microbes on their lids than asymptomatic wearers. The foam cleanser alone reduced the number of microbes on eyelids of symptomatic wearers by approximately 50% within 7-10 days after treatment. Treatment with microblepharon exfoliation reduced microbe numbers by 60% in the same post-treatment timeframe. Gram-negative bacteria were isolated from symptomatic lens wearers only and were significantly reduced from baseline to follow-up with both treatments.

This data points to the importance of contact lens wearers maintaining good lid hygiene. Practitioners should consider treating the lids of contact lens wearers who are complaining of discomfort during wear and also talking to the wearers about how they could improve the hygiene of their lids.

Sowjanya Siddireddy is a clinician and researcher at the School of Optometry and Vision Science at the University of New South Wales in Sydney, working with research fellows Dr Ajay Kumar Vijay and Dr Jackie Tan-Showyin, and with Professor Mark Willcox. Prof Wilcox specialises in ocular microbiology, ocular inflammation and infection and bio-prospecting. His current research focuses on understanding the aetiology of adverse events and comfort during contact lens wear, including adhesion and biofilm formation of ocular pathogenic microbes and development of novel antimicrobial surfaces.