Managing Contact Lens-Related Dry Eye in Orthokeratology for Pediatric Myopia

Overview

Orthokeratology (ortho-k) effectively slows axial elongation in pediatric myopia but can induce contact lens-related dry eye (CLDE) due to corneal epithelial disruption. Proper lens fitting, early detection of epithelial defects, and supportive therapies are critical to maintaining lens wear and ocular surface health.

Background

Orthokeratology lenses reshape the cornea overnight to reduce myopia progression in children. However, the mechanical pressure and overnight wear environment can compromise corneal epithelial integrity, leading to tear film instability and dry eye symptoms. Corneal epithelial defects trigger inflammatory cascades and nerve dysfunction, exacerbating ocular surface dryness. Managing these complications is essential to ensure treatment success and patient comfort.

Data Highlights

Key mechanisms contributing to CLDE in ortho-k patients include mechanical trauma from lens pressure, tear film instability due to epithelial damage, reflex tear dysfunction from nerve exposure, and inflammatory cytokine activation (IL-1, IL-6, TNF-α). Early morning follow-up is recommended to detect transient epithelial defects. Proper lens centration and movement assessment are vital to prevent persistent corneal staining.

Key Findings

• Orthokeratology lenses induce temporary corneal epithelial redistribution causing mechanical trauma and epithelial defects.
• Corneal epithelial damage disrupts mucin secretion, impairing tear film adhesion and causing dry eye symptoms.
• Exposure of corneal nerves from epithelial defects triggers reflex tearing initially but may lead to nerve desensitization and reduced basal tear production if untreated.
• Inflammatory cytokines released due to epithelial injury exacerbate tear film instability and ocular surface damage.
• Suboptimal lens fit is the primary cause of dry eye in ortho-k wearers; careful assessment of lens centration and movement is essential.
• Management includes preservative-free artificial tears, lid hygiene for meibomian gland optimization, and routine follow-ups to detect subtle lens fitting changes and corneal defects.

Clinical Implications

Clinicians should prioritize optimal ortho-k lens fitting to minimize mechanical trauma and epithelial damage. Early morning post-wear examinations help identify transient epithelial defects for timely intervention. Adjunctive treatments such as preservative-free artificial tears and lid hygiene improve ocular surface health and patient comfort, supporting sustained lens wear in pediatric myopia management.

Conclusion

Effective management of contact lens-related dry eye in orthokeratology involves addressing mechanical, tear film, neural, and inflammatory factors primarily through proper lens fitting and supportive ocular surface care. This approach ensures treatment efficacy and enhances quality of life for pediatric myopia patients.

References

1. Liu YM, Xie P. 2016 -- The Safety of Orthokeratology: A Systematic Review
2. Zhang J et al. 2020 -- Redistribution of the corneal epithelium after overnight orthokeratology
3. Berry M et al. 2008 -- Mucins and ocular signs in contact lens wear
4. Pattan HF et al. 2024 -- In vivo assessment of corneal epithelial cells in ortho-k wearers
5. Cho WH et al. 2020 -- Tear film spatial instability in pediatric myopia treatment
6. Carracedo G et al. 2012 -- Changes in diadenosine polyphosphates during orthokeratology
7. González-Pérez J et al. 2012 -- Long-term corneal changes and tear inflammatory mediators after orthokeratology