The College of Optometrists

Had a patient today who has suffered from Lupus for 10 years. She's on a combination of drugs (incl steroid, immunosupressants) and she wants to wear contact lenses (Rx is -3.25 ish). Her eyes show signs of dryness (ITBUT of 6 sec R&L) but no other problems. I was thinking 1 day acuvue moist or oaysis?

Does anyone know of any contraindications of fitting CL to Lupus sufferers?

Any advice welcome!

well - part time wear is okay -but she has a reduced immune system and the lupus will go up and down as well.

Personally, I know these people can enjoy wearing lenses - but for me it has to be daily disposables / part time only. No point in pushing the eyes to the limit, and getting blepharitis or what ever.

I don't think there are any contra indications as such - it would be upto yr opinion as lupus is so variable. You can't say 'no' with out due reason. Her tears are dry, and she will have a degree of blepharitis (which goes with dry eye). THe drugs dry the eyes out as well. So treat the bleph first and get her tears up with omega 3 oils etc.

I normally put the pros and cons of cl use - and put it to her what she thinks. You can get some cracking spex these days. You would have to teach her how to monitor her eyes and report urgently any problem. For fun, evening and weekend only. palf

Thanks palfi. I wasn't really comfortable supplying her with anything other than dailies due to her tear film etc. I did discuss everything with her today (got her back for a chat), she's decided to get specs first, then consider dialies as the cost is a factor. I'm happy for her to try dailies, but have a gut feeling that she'll over wear. Also she wanted to try coloured lenses which I discouraged - from my pre-reg year I remember people complaining of more frequent dryness with these, anyone found this?

I gave a talk to the local Lupus support group about 6 months ago. The feedback from them was that amongst their eye problems was certainly dry eyes, but above all else, photophobia- to the point of making their lives miserable. They have been getting UV filters fitted to their cars- and I discussed the various lens options available.

brill Zinnia - well done. You must tell her in a very matter of fact way that if you think she is being irresponsible with her wear - then you will have to be responsible for her which may mean discontinue wear in favour of a hospital cl dept. That should focus her mind! All you are doing is helping her health and safety aspects of cl use so she can enjoy the lenses as a treat. In that way you are enpowering her and making her an expert patient. Very modern way to look at it - and nothing to fear. Just because you can kill yourself in a car - a garage does not stop you from buying one - but they will explain to you how to drive safely. all the best = palf

I have never known any lupus person come to grief with cls. Most use comfort drops and like the freedom of cls. All of them have been fully informed to maker their health choices.

er.. one bit - if she is on steroids - make sure you monitor her for cataracts and also glaucoma, especially if its over 10mg per day for more than 1 year.

er... lil bit more!

How to tell dry eye.

Well as you know measuring tbuts etc is very inaccurate and prooves little anyway. (10secs are okay).

There are many reasons for this being not a good way - but this is a better way to tell the tear film. I explained this before - so I hope I ma not repeating myself(!). I discovered this myself ages ago and call this palfi's method. Basically, you get the peroson to look up and then study the tear meniscus. In a normal eye the tear meniscus will be stable on any position of gaze. BUT on dry eye - the tear meniscus will drop on up gaze. In very dry eye the tear meniscus will dissapear behind the lower lid margin (contra indication for cls). It never fails and I want you to use this in yr tear assessment. The reason, is that in dry eye there are immunological changes that cause the lids to thicken - and this thickening causes the lower lid margin to pout on up gaze. The tear meniscus falls into the gap between lid and globe - and so drops. Give it a go!

palfi's own - so you won't read that in a book!