Effect of hydrogel lens wear on tear film stability

Noninvasive break-up time (NIBUT) of the tears was measured in a controlled, randomized, double-masked study to assess: (1) the stability of the prelens tear film during wear of new high and low water content lenses and (2) the stability of the precorneal tear film following lens removal after 1 h of wear. The prelens tear film NIBUT of 6 subjects was found to be relatively constant over a 1-h wearing period, averaging 6.1 +/- 1.1 s (mean +/- SEM). These values were significantly (Scheffe's S test, p less than 0.05) lower than those recorded for the precorneal tear film before lens insertion (33.5 +/- 10.6; mean +/- SEM), although 85% of prelens tear film NIBUT's were greater than the 3-s average interblink period reported previously for soft lens wearers. After lens removal, precorneal tear film NIBUT was reduced significantly compared to prewear levels (Scheffe's S test, p less than 0.05) for up to 15 min. Application of the monomolecular growth model to the NIBUT recovery data revealed a half-time for recovery of 6.0 min, with recovery 95% complete 25.8 min after lens removal. Lens type was not a significant factor in tear film stability, either during wear or after lens removal. The basis for reduced precorneal tear film NIBUT after lens removal is unknown; however, a disruption of the mucin layer coating the corneal epithelium is the most likely mechanism. Indeed, the technique of measuring precorneal tear film NIBUT after lens removal may be a useful determinant of the extent to which contact lens wear disrupts the precorneal mucin layer, providing an indication of the susceptibility of the cornea to a variety of complications.