title: How contact lens comfort may be influenced by psychiatric and psychological conditions and mechanisms.
abstract: End-of-day soft contact lens awareness, dryness and discomfort are common related problems and may be associated with lens surface dryness and soiling as well as signs of ocular discomfort. Similar symptoms may be reported by patients who do not have obviously degraded lenses or ocular signs of discomfort. This review examines some psychiatric and psychological conditions and mechanisms which may predispose toward or enhance the likelihood of these symptoms occurring and becoming a problem. For example, conditions such as depression, anxiety and stress may lower the threshold for the perception of discomfort. Chronic ocular inflammation associated with contact lens wear may result in neuroplastic lowering of nociceptive thresholds and enhancement of the perception of discomfort. End-of-day tiredness and reduced levels of demand from top-down activity may make it harder to maintain goal-relevant attention and the associated ability to inhibit sensory stimuli (such as lens awareness) that would otherwise not capture attention. Lens surface lubricity experienced on lens insertion may be higher than normal for corneal or conjunctival surfaces and create expectations of very high comfort levels, which are not apparent after lens surface dehydration, soiling or other lens changes have accumulated during the day. Psychiatric and psychological conditions and mechanisms may not only contribute to the perception of discomfort, when the lens and ocular condition appear normal but also may contribute to the perception of discomfort, when lens surface drying and soiling are evident and/or discomfort such as chronic ocular inflammation is apparent.
authors.affiliation: School of Optometry and Vision Science, University of New South Wales, Kensington, NSW, Australia. c.mcmonnies@unsw.edu.au.
authors.forename: Charles W
authors.initials: CW
authors.lastname: McMonnies
mesh_terms: D003261:Contact Lenses / Q000523:psychology*; D006801:Humans; D017060:Patient Satisfaction; D011618:Psychotic Disorders / Q000150:complications* / Q000523:psychology; D012030:Refractive Errors / Q000150:complications / Q000628:therapy*
keywords: comfort; contact lenses; psychiatry; psychology