Pinguecula And Contact Lenses

Introduction

Pinguecula is a degenerated part of the bulbar conjunctiva (white part of the eye). You can see it as a greyish-white or a yellow mass prominently on the white region of the eye. The risk factors for developing a pinguecula are:¹

• Exposure to UV light
• Trauma
• Dust, sand, wind (working outdoors)
• Old age 
• Contact lens (hard>soft lens)

Importance of eye health

In the process of focusing on crash dieting and workout routines to maintain our overall physical health, we often ignore our eye health. Around 1 billion people suffer from preventable causes of blindness globally.² Strict check-ups, diet, and protection is necessary to prevent common diseases like pinguecula, diabetic retinopathy and glaucoma. 

Pinguecula and contact lenses

How do contact lenses affect pinguecula?

Wearing contact lenses eventually contributes to the development of pinguecula because of the irritation in the eye. 

• The lens material might be incompatible with the eye 
• Individual allergies can exacerbate irritation
• Dehydration (dry eyes) and friction from constant wear and removal of the lens

These could be a few reasons for irritation in the eye.³ 

Different types of contact lenses

There are three types of contact lenses based on the material they are made from:⁴

• Soft/hydrogel contact lenses - hydroxyethyl methacrylate
• Rigid gas permeable contact lenses - silicon and cellulose acetate butyrate
• Rigid non-gas permeable contact lenses - polymethylmethacrylate

The hydrogel lenses are commonly called soft contact lenses (SCL), and the other two come under hard contact lenses (HCL) despite the gas-permeable lenses offering more breathability to the eyes. It is also important to know that SCLs have a larger surface area. More importantly, they are safer because they do not stimulate the eye surface constantly. In contrast, HCLs have greater stiffness, which increases the chances of irritation.⁵

Best contact lenses for pinguecula

Scleral contact lenses

These lenses fit over your cornea (the clear area) and a part of the sclera (the white part of the eye). These are very useful for individuals with dry eyes or corneal problems (like keratoconus). However, if you have a pinguecula, scleral lens edges can irritate the lesion. Some solutions like increasing or reducing the lens diameter and edge-notching may help pinguecula patients with scleral lenses.⁶ 

Soft contact lenses

These are the best for reducing irritation to the eyes. Made up of hydrogel, their larger diameter and breathable material allow for maximum oxygen delivery to the cornea. This means that overall, there is less chance of dehydration and dry eyes.⁷ 

Gas-permeable contact lenses

These unique lenses provide both breathability for eye comfort and retention while being rigid. This property is used to make lenses for the treatment of chronic eye conditions (use of medicated gas-permeable lenses for specific diseases). The medication is retained on the surface of the eye for its therapeutic effect while also providing comfort to the patient.

Tips for wearing contact lenses with pinguecula

Proper lens hygiene 

• Don’t share your lenses with anyone
• Follow the contact lens care system on the package or as prescribed by your optometrist.
• Rub the lens after wear for 10-20 seconds and then remove the microorganisms and debris. Rinse immediately
• Do not use contact lens solutions past their expiry date
• Use preservative-free eye drops if you have any eye problems while wearing the lens
• If you have to wear lenses occasionally, use disposable lenses. They are easier to use and have fewer complications because of no storage-related concerns
• Wash and dry your hands thoroughly before wearing/removing the lens
• Do not use tap water or homemade saline solution to clean/store your lens
• During air travel, there is reduced humidity and oxygen availability to the eyes. Use lubricating eye drops to avoid irritation
• Avoid wearing the lenses in a bathtub or any body of water. If necessary, wear the lens and secure it tightly with swimming goggles⁸

Contact lenses with cosmetics

• Before applying makeup, put on soft contact lenses. After applying makeup, put on rigid gas-permeable lenses. While removing, make sure to remove lenses before removing make-up.
• Avoid eyeliner on the watermark of the eye. 
• Avoid waterproof eye products, as they cannot be easily removed and may also stain the lens.
• Close your eyes while using any spray such as hairspray or while using a hair dryer.

Frequent eye exams

Regular eye exams from your local ophthalmologist can help you make informed decisions on your eye health. If you have chronic conditions like diabetes, visit your ophthalmologist yearly. If not, visit at least once in two years.

Use of eye drops

Eye drops are necessary for individuals with dry eyes or irritation to avoid further abrasion on the eye surface. Artificial tears, topical antibiotics, and/or topical steroids may be prescribed by your ophthalmologist according to the severity of inflammation. If the pinguecula is inflamed (pingueculitis), a cold compress can also help.

Avoiding UV radiation

Understand that ultraviolet radiation does cause significant damage to the eye, not just the skin. Use measures like:⁸

• Using contact lenses that filter ultra-violet radiation (like senofilcon A class I UV-blocking contact lenses)  
• Other useful UV lenses with UV protection are- polycarbonate and high index lenses, lenses with CR-39 polymer, and transition and polarised lenses.
• Avoid direct and prolonged exposure to sunlight.
• Use sunglasses, wide-brimmed hats or visors if you have to be outdoors for long periods.

Summary

Pinguecula, a degenerated part of the bulbar conjunctiva, manifests as a greyish-white or yellow mass on the eye's white region. Some factors that increase the chances of developing pinguecula are exposure to UV rays, trauma, outdoor work, old age, and contact lens use, with hard lenses posing higher risks.

This article discusses the risk factors of pinguecula and also examines the impact of contact lenses on the development of pinguecula, and describes the different types of contact lenses available, such as soft contact lenses, rigid gas permeable lenses, and scleral contact lenses.  Individuals with pinguecula are recommended to wear soft contact lenses or gas-permeable contact lenses. They are also required to follow proper lens hygiene measures, avoid UV radiation, avoid swimming with the lenses and be cautious while using cosmetics. It is also important to schedule regular eye exams and use eye drops if you have dry eyes or irritation. It is essential to prioritise eye health equally as physical health because most of the common eye diseases that cause permanent vision loss or blindness can be treated if caught early.