Improving ocular surface comfort in contact lens wearers

Published:November 25, 2021DOI:



      Contact lens discomfort (CLD) is a major concern that can lead to the decreased or abandoned use of contact lenses. Contact lens users with dry eye disease are more likely to present with CLD. This study was conducted to evaluate the efficacy of a bioprotective preservative free, hypotonic, 0.15% hyaluronic acid (HA)-3% Trehalose artificial tear in managing dry eye symptoms in contact lens wearers.


      A prospective, single-arm, observational pilot study to evaluate the effectiveness of treatment with HA-Trehalose artificial tears in contact lens wearers (N = 33) aged 18–45 years with symptoms of ocular discomfort. Participants used a preservative-free, hypotonic HA-Trehalose artificial tear (1 drop/4 times per day) for 84 days. Participants were assessed using Visual Analogue Scale (VAS) for dry eye symptoms (pain, photophobia, dry eye sensation, blurry vision, foreign body sensation, itching, tingling/burning, and sticky eye feeling), Ocular Surface Disease Index (OSDI), Contact Lens Dry Eye questionnaire (CLDEQ-8), Berkley Dry Eye Flow-Chart (DEFC) on Day 0 and Day 84 and tear break-up time (TBUT), ocular surface staining with fluorescein and lissamine green, tear meniscus evaluation, and visual acuity on Day 0, 35, and 84.


      All VAS symptoms (except tingling/burning and sticky eye feeling), OSDI, CLEDQ-8, and DEFC showed statistically significant (p < 0.05) improvement from baseline (Day 0) to Day 84. Similarly, corneal (fluorescein) and conjunctival (lissamine green) quality improved during the study (p < 0.05 at Day 84 versus baseline). Tear break-up time (TBUT), conjunctival (lissamine green) staining, and tear meniscus decreased but the changes were not statistically significant. Visual acuity did not change during the study. There were no ocular or systemic adverse events.


      This study showed that the instillation of a preservative-free, hypotonic, HA-Trehalose artificial tear in contact lenses wearers with dry eye syndrome significantly improved symptoms and reduced associated signs such as corneal and conjunctival staining.


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        • Lim C.H.L.
        • Stapleton F.
        • Mehta J.S.
        Review of contact lens–related complications.
        Eye Contact Lens. 2018; 44: S1-S10
        • Villani E.
        • Canton V.
        • Magnani F.
        • Viola F.
        • Nucci P.
        • Ratiglia R.
        The aging meibomian gland: an in vivo confocal study.
        Investig Opthalmology Vis Sci. 2013; 54: 4735
      1. Craig JP, Willcox MDP, Argüeso P, Maissa C, Stahl U, Tomlinson A, et al. The TFOS International Workshop on Contact Lens Discomfort: Report of the contact lens interactions with the tear film subcommittee. Investig Ophthalmol Vis Sci 2013;54.

        • Lemp M.A.
        • Bielory L.
        Contact lenses and associated anterior segment disorders: dry eye disease, blepharitis, and allergy.
        Immunol Allergy Clin North Am. 2008; 28: 105-117
      2. Nichols KK, Redfern RL, Jacob JT, Nelson JD, Fonn D, Forstot SL, et al. The TFOS International Workshop on Contact Lens Discomfort: Report of the definition and classification subcommittee. Investig Ophthalmol Vis Sci 2013;54.

        • Pucker A.D.
        • Tichenor A.A.
        A review of contact lens dropout.
        Clin Optom. 2020; 12: 85-94
        • Guillon M.
        Are silicone hydrogel contact lenses more comfortable than hydrogel contact lenses?.
        Eye Contact Lens. 2013; 39: 86-92
      3. Dumbleton K, Caffery B, Dogru M, Hickson-Curran S, Kern J, Kojima T, et al. The TFOS International Workshop on Contact Lens Discomfort: Report of the subcommittee on epidemiology. Investig Ophthalmol Vis Sci 2013;54.

        • Nichols J.J.
        • Ziegler C.
        • Mitchell G.L.
        • Nichols K.K.
        Self-reported dry eye disease across refractive modalities.
        Investig Ophthalmol Vis Sci. 2005; 46: 1911-1914
        • Downie L.E.
        • Craig J.P.
        Tear film evaluation and management in soft contact lens wear: a systematic approach.
        Clin Exp Optom. 2017; 100: 438-458
      4. Jones L, Brennan NA, González-Méijome J, Lally J, Maldonado-Codina C, Schmidt TA, et al. The TFOS International Workshop on Contact Lens Discomfort: Report of the contact lens materials, design, and care subcommittee. Investig Ophthalmol Vis Sci 2013;54.

        • Fondi K.
        • Wozniak P.A.
        • Schmidl D.
        • Bata A.M.
        • Witkowska K.J.
        • Popa-Cherecheanu A.
        • et al.
        Effect of hyaluronic acid/trehalose in two different formulations on signs and symptoms in patients with moderate to severe dry eye disease.
        J Ophthalmol. 2018; 2018: 1-7
      5. Baudouin C, Aragona P, Messmer EM, Tomlinson A, Calonge M, Boboridis KG, et al. Role of hyperosmolarity in the pathogenesis and management of dry eye disease: Proceedings of the ocean group meeting. Ocul Surf 2013;11:246–58.

        • Jain N.K.
        • Roy I.
        Effect of trehalose on protein structure.
        Protein Sci. 2009; 18: 24-36
      6. Čejková J, Čejka Č, Luyckx J. Trehalose treatment accelerates the healing of UVB-irradiated corneas. Comparative immunohistochemical studies on corneal cryostat sections and corneal impression cytology. Histol Histopathol 2012;27:1029–40.

        • Li J.
        • Roubeix C.
        • Wang Y.
        • Shi S.
        • Liu G.
        • Baudouin C.
        • et al.
        Therapeutic efficacy of trehalose eye drops for treatment of murine dry eye induced by an intelligently controlled environmental system.
        Mol Vis. 2012; 18: 317-329
        • Nakamura M.
        • Hikida M.
        • Nakano T.
        • Ito S.
        • Hamano T.
        • Kinoshita S.
        Characterization of water retentive properties of hyaluronan.
        Cornea. 1993; 12: 433-436
      7. Snibson GR, Greaves JL, Soper NDW, Tiffany JM,Wilson CG, Bron AJ. Ocular surface residence times of artificial tear soluctions. Cornea 1992;11:288-293.

        • Wozniak P.A.
        • Schmidl D.
        • Bata A.M.
        • Fondi K.
        • Witkowska K.J.
        • Aranha dos Santos V.
        • et al.
        Effect of different lubricant eye gels on tear film thickness as measured with ultrahigh-resolution optical coherence tomography.
        Acta Ophthalmol. 2017; 95: e307-e313
        • Fariselli C.
        • Giannaccare G.
        • Fresina M.
        • Versura P.
        Trehalose/hyaluronate eyedrop effects on ocular surface inflammatory markers and mucin expression in dry eye patients.
        Clin Ophthalmol. 2018; 12: 1293-1300
        • Novack G.D.
        • Asbell P.
        • Barabino S.
        • Bergamini M.V.W.
        • Ciolino J.B.
        • Foulks G.N.
        • et al.
        TFOS DEWS II clinical trial design report.
        Ocul Surf. 2017; 15: 629-649
        • Burckhardt C.S.
        • Jones K.D.
        Adult measures of pain: The McGill Pain Questionnaire (MPQ), Rheumatoid Arthritis Pain Scale (RAPS), Short-Form McGill Pain Questionnaire (SF-MPQ), Verbal Descriptive Scale (VDS), Visual Analog Scale (VAS), and West Haven-Yale Multidisciplinary Pain Inven.
        Arthritis Rheum. 2003; 49: S96-S104
        • Schiffman R.M.
        • Christianson M.D.
        • Jacobsen G.
        • Hirsch J.D.
        • Reis B.L.
        Reliability and validity of the ocular surface disease index.
        Arch Ophthalmol. 2000; 118: 615
        • Chalmers R.L.
        • Begley C.G.
        • Moody K.
        • Hickson-Curran S.B.
        Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) and opinion of contact lens performance.
        Optom Vis Sci. 2012; 89: 1435-1442
        • Koh S.
        • Chalmers R.
        • Kabata D.
        • Shintani A.
        • Nishida K.
        Translation and validation of the 8-item Contact Lens Dry Eye Questionnaire (CLDEQ-8) among Japanese soft contact lens wearers: The J-CLDEQ-8.
        Contact Lens Anterior Eye. 2019; 42: 533-539
        • Tran N.
        • Graham A.D.
        • Lin M.C.
        Contact lens & anterior eye ethnic differences in dry eye symptoms: effects of corneal staining and length of contact lens wear.
        Contact Lens Anterior Eye. 2013; 36: 281-288
      8. Bron AJ, Abelson MB, Ousler G, Pearce E, Tomlinson A, Yokoi N. Methodologies to diagnose and monitor dry eye disease: Report of the Diagnostic Methodology Sub- committee of the International Dry Eye Workshop. Ocul Surf 2007;5:108–52.

        • Bron A.J.
        • Evans V.E.
        • Smith J.A.
        Grading of corneal and conjunctival staining in the context of other dry eye tests.
        Cornea. 2003; 22: 640-650
        • van Bijsterveld O.P.
        Diagnostic tests in the Sicca syndrome.
        Arch Ophthalmol. 1969; 82: 10-14
        • Khurana A.K.
        • Chaudhary R.
        • Ahluwalia B.K.
        • Gupta S.
        Tear film profile in dry eye.
        Acta Ophthalmol. 1991; 69: 79-86
      9. Ferris FL, Kassoff A, Bresnick GH, Bailey I. New visual acuity charts for clinical research. Am J Ophthalmol 1982;94:91–6.

        • Razali N.
        • Wah Y.
        Power comparisons of shapiro-wilk, kolmogorov-smirnov, lilliefors and anderson-darling tests.
        J Stat Model Anal. 2011; 2: 21-33
        • Kazis L.E.
        • Anderson J.J.
        • Meenan R.F.
        Effect sizes for interpreting changes in health status.
        Med Care. 1989; 27: S178-S189
      10. Markoulli M, Optometry SK-C, 2017 U. Contact lens wear and dry eyes: challenges and solutions. Clin Optom 2017;9:41.

      11. Nichols JJ, Willcox MD, Bron AJ, Belmonte C, Ciolino JB, Craig JP, et al. The TFOS international workshop on contact lens discomfort: executive summary. Invest Ophthalmol Vis Sci 2013;54:TFOS7–13.

        • Chiambaretta F.
        • Doan S.
        • Labetoulle M.
        • Rocher N.
        • El Fekih L.
        • Messaoud R.
        • et al.
        A randomized, controlled study of the efficacy and safety of a new eyedrop formulation for moderate to severe dry eye syndrome.
        Eur J Ophthalmol. 2017; 27: 1-9
        • Doan S.
        • Bremond-Gignac D.
        • Chiambaretta F.
        Comparison of the effect of a hyaluronate–trehalose solution to hyaluronate alone on Ocular Surface Disease Index in patients with moderate to severe dry eye disease.
        Curr Med Res Opin. 2018; 34: 1373-1376
      12. Le Q, Zhou X, Ge L,Wu L, Hong J, Xu J. Impact of dry eye syndrome on vision-related quality of life in a non-clinic-based general population. BMC Ophthalmol 2012;12:22.

        • Ousler G.W.
        • Hagberg K.W.
        • Schindelar M.
        • Welch D.
        • Abelson M.B.
        The ocular protection index.
        Cornea. 2008; 27: 509-513