Clinical Scorecard: Myopia: Managing Dry Eye in Orthokeratology Patients

At a Glance

Key Highlights

• Orthokeratology effectively slows axial elongation in pediatric myopia but can induce dry eye through corneal epithelial disruption.
• Corneal epithelial integrity is crucial for tear film stability; epithelial defects lead to tear film instability and dry eye symptoms.
• Proper lens fit, early detection of epithelial defects, and management of lid hygiene are essential to prevent and treat CLDE in ortho-k patients.

Guideline-Based Recommendations

Diagnosis

• Schedule 1-day follow-up preferably in the early morning to detect subtle epithelial defects before they heal.
• Assess lens centration and movement to ensure uniform weight distribution and identify causes of corneal staining.
• Monitor for corneal epithelial staining as a clinical sign of lens-induced defects.

Management

• Ensure optimal lens fit to prevent mechanical trauma and epithelial damage.
• Use preservative-free artificial tears before and after lens wear for mild, chronic dry eye symptoms without epithelial defects.
• Emphasize rigorous lid hygiene and warm compresses for patients with pre-existing lid conditions to optimize meibomian gland function.

Monitoring & Follow-up

• Conduct routine follow-up visits to identify subtle changes in lens fitting and early corneal defects.
• Promptly address persistent, dense, or coalesced corneal staining to prevent worsening symptoms.
• Monitor for signs of chronic inflammation and corneal surface compromise.

Risks

• Persistent epithelial defects can lead to nerve desensitization, reducing basal tear production and worsening dry eye.
• Chronic inflammation may cause corneal thinning, scarring, and further epithelial compromise.
• Suboptimal lens fit is the primary cause of ocular dryness in ortho-k lens wear among children.

Patient & Prescribing Data

Children undergoing overnight orthokeratology for myopia control

Early morning follow-up and careful lens fitting are critical to detect and manage epithelial defects; preservative-free artificial tears and lid hygiene support symptom control.

Clinical Best Practices

• Schedule early morning follow-up visits to maximize detection of transient epithelial defects.
• Carefully assess and adjust lens centration and movement to ensure uniform pressure distribution.
• Use preservative-free artificial tears for mild dry eye symptoms without epithelial damage.
• Implement rigorous lid hygiene and warm compresses for patients with lid conditions.
• Maintain routine monitoring to prevent progression of corneal surface damage and inflammation.

References

• Liu YM, Xie P. The Safety of Orthokeratology--A Systematic Review. Eye Contact Lens. 2016
• Zhang J et al. Redistribution of the corneal epithelium after overnight wear of orthokeratology lenses. Cont Lens Anterior Eye. 2020
• Berry M et al. Mucins and ocular signs in contact lens wear. Optom Vis Sci. 2008
• Pattan HF et al. In vivo assessment of corneal epithelial cells in orthokeratology lens wearers. Optom Vis Sci. 2024
• Cho WH et al. Analysis of tear film spatial instability for pediatric myopia under treatment. Sci Rep. 2020
• Carracedo G et al. Changes in diadenosine polyphosphates during orthokeratology lens wear. Invest Ophthalmol Vis Sci. 2012
• González-Pérez J et al. Long-term changes in corneal structure and tear inflammatory mediators after orthokeratology. Invest Ophthalmol Vis Sci. 2012