Eye Drop Review: Best Drops for Contact Lens Wearers

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If you wear contact lenses, you’ve likely experienced the irritating symptoms of contact lens-related dry eye: that afternoon dryness, the feeling of a foreign body, or the sudden blur that requires a quick blink. For many, contact lens wear can turn a mild dry eye into a significant daily discomfort.

The good news is that there are many excellent eye drops available. The challenge, however, is knowing which ones are safe and effective to use while your lenses are in. Using the wrong drop can lead to blurred vision, lens damage, and even cause damage to the eye.

Today, we’ll be looking at the several fundamental rules for choosing the best eye drops for contact lens wearers and highlighting why you need to be careful with some of the more advanced dry eye therapies.

How does contact lens wear affect your tear film?

The tear film consists of three continuous layers: the mucin layer, which is the closest layer to the eye, acts as the foundation of the tear film. The aqueous layer, or watery layer, forms the bulk of the tear film and helps clean, protect, and transport nutrients and oxygen to the cornea, as well as trapping and washing away particles. The lipid layer, cover the aqueous layer, and functions to prevent drying of the aqueous layer.

A contact lens floats in the tear film, and divides the tear film into a pre-lens layer and a post lens layer. The pre-lens layer does not have a foundation (the mucin layer) to attach to, and therefore breaks up and evaporates more readily compared to the normal tear film. The post lens layer is somewhat trapped under the lens and doesn't get refreshed, as it normally would, with blinking. This stagnation causes build up of metabolic by products, debris and dead epithelial cells, and inflammatory mediators.

The Golden Rule: Preservative-Free Eye Drops Are Essential

When it comes to contact lenses, the number one rule is: choose preservative-free eye drops.

Most bottled, multi-dose eye drops contain preservatives—the most common being benzalkonium chloride. These chemicals are designed to kill bacteria and fungi that may be introduced into the bottle, extending the shelf life of the product. However, the chemical structure of preservatives, particularly BAK, is such that they are readily absorbed by the porous material of a soft contact lens. This accumulation causes ongoing chemical trauma to the corneal epithelium, leading to inflammation and irritation. This worsens the "dryness" you were trying to treat.

I often see patients who try one eye drop, feel it doesn’t provide instant relief, and quickly move on to a second or third brand. This "product hopping" can actually be more detrimental than sticking to a single, mediocre eye drop. This is because different brands utilize different preservatives and stabilizing agents. When you mix multiple products in a short period, the chemicals can interact with each other, creating a "chemical cocktail", which compounds the toxic effects, leading to further disruption and irritation.

Avoid Suspensions and Emulsions

In general, you should avoid most suspension and emulsion-based drops while wearing your contact lenses. These drops are designed to coat the eye with a milky or particulate layer to maximize drug delivery or lipid replacement. When applied over a contact lens, however, they can can cause blurry vision by forming a film that adhere to the lens surface. Furthermore, using these drops with a contact lens can create white, powdery deposits that either stay on the surface of the lens or gets trapped between the lens and the eye, causing further discomfort.

If you do need to use a suspension or emulsion eye drops, such as cyclosporine, you should use them after removing your contact lenses first or before inserting the contact lenses

Our Verdict

Choosing the right eye drop as a contact lens wearer is more about what you exclude than what you include.

1. Avoid using an eye drop that contains preservatives while wearing your lenses.

2. AVOID any milky or oily-looking eye drops while the lenses are in.

3. PRIORITISE clear, simple, preservative-free single-use vials or OSD bottles for on-the-go relief.

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