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Cochrane corner: lubricating drops for contact lens discomfort in adults

Eye volume 39, pages 2330–2331 (2025)Cite this article

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Contact lenses (CLs) provide an effective alternative to spectacles and refractive surgery for correcting refractive error, offering many patients a convenient means of improving visual acuity [1, 2]. Compared to spectacles, CLs offer distinct advantages, including the absence of magnification or minification effects, enhanced peripheral vision, greater freedom during sports and outdoor activities, a more natural facial appearance, and less inconvenience if lost or damaged [3] Additionally, CL use has been associated with improvements in overall quality of life [4]. Despite these benefits, CL dropout remains a significant issue, affecting more than one-fifth of wearers (mean 21.7%, 95% confidence interval [CI] 12.0% to 27.4%) [5]. Discomfort was identified as the most common reason for discontinuation among established wearers [5]. Factors contributing to CL discomfort include (1) lens parameters such as material, design, wear modality, and lens care solutions; (2) patient and environmental factors like age, gender, and medications; (3) the underlying ocular surface health, with meibomian gland dysfunction consistently found to exacerbate discomfort and predispose to dropout [6, 7]. CL dropout remains a concern for not only patients, but also for optometrists performing CL fitting and for CL manufacturers [1]. This ongoing challenge affects patients by reducing satisfaction and quality of life, while also impacting optometrists and contact lens manufacturers by contributing to inefficiencies in clinical care and affecting practice patterns, revenue, and industry growth.

A recent Cochrane systematic review evaluated the effectiveness of lubricating eye drops on alleviating CL discomfort based on findings from seven randomized controlled trials (RCTs) involving 463 adult participants (reference). When comparing lubricating drops to no treatment, very low-certainty evidence suggested a possible reduction in CL discomfort, though results were heterogeneous across studies and the estimates were imprecise (mean reduction in symptom scores on a 37-point scale was −5.9, 95% CI −3.74 to −8.05; 2 RCTs; 119 participants). In contrast, when lubricating drops were compared directly to saline, the evidence showed little to no difference in symptom relief (mean change in symptom scores on a 100-point scale was 9.50, 95% CI −4.65 to 23.65; 1 RCT; 76 participants; very low certainty). Similarly, low-certainty evidence on objective clinical signs, such as corneal fluorescein staining (e.g., mean difference in the extent of staining on a 20-point scale was -0.15, 95% CI -0.86 to 0.56; 2 RCTs; 119 participants) and conjunctival hyperaemia (e.g., mean difference in the nasal region scores was 0.10, 95% CI −0.29 to 0.49; 1 RCT; 73 participant), indicated minimal impact of lubricating drops compared to no treatment. Encouragingly, no vision-threatening adverse events, such as microbial keratitis or inflammatory corneal infiltrates, were reported in any treatment group within the trial period lasting one to four weeks.

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Funding

SL reported salary support by a grant from the National Eye Institute, USA (UG1EY020522); payment to the institution.

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Authors and Affiliations

  1. Sue-Anschutz Rodgers Eye Center, University of Colorado School of Medicine, Aurora, CO, USA

    Kaleb S. Abbott, Darren G. Gregory & Su-Hsun Liu

  2. Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA

    Su-Hsun Liu

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  1. Kaleb S. Abbott
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  2. Darren G. Gregory
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All authors contributed to the article concept, manuscript preparation, and revision.

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Correspondence to Kaleb S. Abbott.

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Abbott, K.S., Gregory, D.G. & Liu, SH. Cochrane corner: lubricating drops for contact lens discomfort in adults. Eye 39, 2330–2331 (2025). https://doi.org/10.1038/s41433-025-03867-2

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