Contact lens discomfort — it's usually the tear film

A contact lens sits directly on the tear film. Under it: a thin layer of fluid. Over it: another thin layer of fluid, and then the oil layer that stops both from evaporating. If any of those three layers weakens, the lens starts to drag, blur, or feel like it's still in when you take it out.

Comfort issues start climbing around age 40 and jump sharply around age 42. Hormonal change, mild meibomian gland dropout and years of blink habits all catch up at once. Under 45, comfort is the main reason for dropout. Over 45, vision and comfort are roughly equal — which is why most dropouts at that age aren't wearing multifocal lenses when they give up.

• • Tear film breakup time — how quickly the film destabilises after a blink.
• • Meibography — the state of the oil glands in your lids, because they set the ceiling on comfort.
• • Surface staining under the lens footprint and at the lid margin.
• • Blink completeness — incomplete blinks in front of a screen are a huge (often silent) driver.
• • Lens material, replacement schedule and solution — sometimes the fix is small.

Depending on what the assessment shows, a plan usually includes:

• • Meibomian gland expression and IRPL if the oil layer is the bottleneck.
• • A preservative-free rewetting drop compatible with lens wear.
• • A daily disposable lens material better matched to your tear type — many people are on the wrong material for their eyes.
• • Screen and blink retraining — 20-20-20, humidifier, blink breaks.
• • Multifocal fit if presbyopia is quietly part of the story.

For a small number of people — particularly with severe dry eye, autoimmune disease, or an irregular cornea — scleral lenses can be transformative. They vault over the cornea and hold a reservoir of fluid against the surface all day. TFOS DEWS II positions them as an option when conventional dry eye therapy isn't enough. We can refer for these when it's the right call.