Welcome to question of the day #258

Eyetools question of the day #258

Many of my myopic patients who wear contact lenses complain of what sounds like dry eye symptoms, but on examination I can find no evidence of dry eye. What is going on?

Discomfort symptoms of dry eye are similar to symptoms associated with binocular vision and accommodative disorders.

Symptoms like blurry/variable vision, end of day fatigue, and eyestrain are reported by people who suffer from dry eye or binocular vision and accommodative disorders.

Myopic people have increased accommodative and vergence demands when they wear their contact lenses compared to when they wear their spectacles.

It is important to remember that around one third of the adult population has a binocular vision or accommodative disorder.

It is very quick and easy to check for a binocular vision abnormality in uncomfortable contact lens wearers. A simple screening with cover test at distance and near, near point of convergence evaluation, and/or aligning prism will uncover signs that vergence or accommodative strain may be contributing to symptoms of discomfort.

It is important to find out if the patient’s symptoms are caused by a binocular vision anomaly since time and money can be wasted treating what sounds like dry eye and/or changing contact lens material or wearing modality.