ORIGINAL ARTICLE  
Effect of Soft Contact Lens Wear  
on Tear Film Breakup Time  
Syeda Rushda Zaidi1, Ali Ayaz Sadiq2, Shua Azam3, Uzma Sattar4, Samia Iqbal5, Huma Ejaz6  
1-6College of Ophthalmology and Allied Vision Sciences, King Edward Medical University, Mayo Hospital, Lahore  
ABSTRACT  
Purpose: To study the effect of soft contact lens wear on tear film breakup time (TFBUT).  
Study Design: Descriptive Observational study.  
Place and Duration of Study: College of Ophthalmology and Allied Vision Sciences, King Edward Medical  
University, Mayo Hospital, Lahore from January to March 2016.  
Material and Methods: Students of King Edward Medical University Lahore wearing soft contact lens for more  
than 3 months with no known ocular pathology were selected by non-probability convenient sampling technique.  
Subjects with history of using any eye drops, history of oral drugs, which could cause dry eye and individuals any  
ocular disease, were excluded from the study. Tear film BUT was tested by using Fluorescein sodium dye and  
examinig under cobalt blue filter of slit lamp. SPSS version 20 is used to analyze the data.  
Results: There were 30 participants with mean age of 24.5 ± 5 years. All were females. Sixty percent were  
wearing corrective lenses, and 40% were wearing cosmetic lenses. Out of 30 patients wearing contact lenses,  
only 6.67% had marginal tear film BUT and none of the patients has shown dry eyes. Individuals using contact  
lenses for 9 – 12 years had decreased BUT as compared to subjects using lenses for 3 – 6 months. 33.33% of  
extended lens wearers had reduced BUT as compared to disposable and daily wearers of contact lenses.  
Discomfort with contact lenses was observed in only 4 patients.  
Conclusion: As the duration of contact lens wear increases, the tear film break-up time decreases. Individuals  
using extended wear contact lenses are more prone to develop decreased TFBUT.  
Key Word: Soft contact lenses, Dry eye syndrome, Tear breakup time.  
How to Cite this Article: Zaidi SR, Sadiq AA, Azam S, Sattar U, Iqbal S and Ejaz H. Effect of Soft Contact Lens  
Wear on Tear Film Breakup Time, Pak J Ophthalmol. 2020, 36 (2): 169-172.  
Doi: 10.36351/pjo.v36i2.1028  
discomfort is due to tear deficiency or excessive tear  
INTRODUCTION  
The lacrimal glands tear film and corneal surface play  
evaporation1.  
A group of symptoms such as grittiness, irritation  
and burning are related to dry eyes. However, an  
inadequate healthy tear layer could lead to over  
production of the lacrimal gland leading to reflex  
tearing2. Epidemiologic literature has recognized  
prevalence rates of dry eye from 33% and 7% in Japan  
and the US respectively3. About 33.7% in Taiwan and  
around 20.7 million people of the total population of  
the US have dry eye syndrome.4,5 Likewise;  
menopausal women are the significant part of the  
population affected by the dry eye problem6.  
a major role to preserve the integrity of the refractive  
surface of the eye, counterattack damage and defend  
the eye contrary to varying biological circumstances.  
Tear film is protects the palpebral conjunctivae, bulbar  
conjunctiva and cornea. Consequently, ocular  
Correspondence to: Syeda Rushda Zaidi  
College of Ophthalmology and Allied Vision Sciences, King  
Edward Medical University, Mayo Hospital, Lahore  
Email: rushdazaidi15@live.com  
169  
Pakistan Journal of Ophthalmology, 2020, Vol. 36 (2): 169-172  
Effect of Soft Contact Lens Wear on Tear Film Breakup Time  
The contact lens absorbs water from the natural  
tear film due to evaporation of the water from its  
surface, which is the primary reason to have the  
symptoms of dry eyes in contact lens wearers7.  
Consequently, the reduced level of tears increases the  
tear film osmolarity which further irritates the eye in  
general and produces discomfort in particular.8  
Contact lenses are used as therapeutic device as well  
as for cosmetic purpose9. About 2% of the world  
population uses contact lenses. The worldwide worth  
of lens market was around 11.7 billion dollars by  
201510. Two third of the population who wear lenses is  
female, and the average age of soft contact lens  
wearers was 31 years11. The comfort level of lenses  
depends upon its softness and stiffness12.  
high mean value of tear film BUT around 33 seconds  
(Figure 1).  
When TFBUT was compared among different  
types of contact lens wearers, it showed that 33.33% of  
extended lens wearers had reduced TFBUT (range 6 –  
15 seconds) as compared to disposable and daily  
wearers who had TFBUT of 35 seconds (Figure 2).  
Discomfort with contact lenses was observed in only 4  
patients. None of the subjects with disposable and  
daily wear lenses had abnormal TFBUT. Fifteen  
individuals were using extended wear and only 2 out  
of 15 had marginal TFBUT.  
35.00  
32.14  
The purpose of this study was to see the effect of  
soft contact lens wear on tear breakup time and to find  
out if the duration of contact lens use has any impact  
on the tear film break up time.  
30.00  
26.26  
25.00  
23.94  
20.00  
13.77  
15.00  
MATERIAL AND METHODS  
10.00  
9.23  
This was a descriptive Observational study conducted  
at College of Ophthalmology and Allied Vision  
Sciences, King Edward Medical University, Mayo  
Hospital, Lahore from January to March 2016.  
Students of King Edward Medical University Lahore  
wearing soft contact lens for more than 3 months with  
no known ocular pathology were selected by non-  
probability convenient sampling technique. Subjects  
with history of using any eye drops, history of oral  
drugs, which could cause dry eye and individuals with  
any ocular disease, were excluded from the study.  
Students with history of Kerato-refractive surgery  
were also excluded. Tear film BUT was tested by  
using Fluorescein sodium dye and examinig under  
cobalt blue filter of slit lamp. SPSS version 20 is used  
to analyze the data.  
5.00  
0.00  
3 - 6  
Months  
6 Months-  
1 Year  
2 - 4  
Years  
5 - 8  
Years  
9 - 12  
Years  
Duration of Wearing Contact Lenses  
Fig. 1: Tear Film BUT in Comparison with Duration of Use.  
RESULTS  
There were 30 participants with mean age of 24.5 ± 5  
years. All were females. Sixty percent were wearing  
corrective lenses, and 40% were wearing cosmetic  
lenses. Out of 30 patients wearing contact lenses, only  
6.67% had marginally decreased tear film BUT and  
none of the participants had dry eyes. However, TF  
BUT decreased with the increased duration of contact  
lens wear. Individuals using contact lenses for 9 – 12  
years had TFBUT around 10 seconds whereas subjects  
with duration of contact lenses for 3 – 6 months had  
Fig. 2: Tear Film BUT in Comparison with type of Contact Lenses.  
Figure 2: 33.33% of extended lens wearers had  
reduced BUT lying in the range of 6 – 15 seconds as  
compared to disposable and daily wearers who had  
TFBUT on average 26 – 35 seconds.  
Pakistan Journal of Ophthalmology, 2020, Vol. 36 (2): 169-172  
170  
Syeda Rushda Zaidi, et al  
DISCUSSION  
Conflict of Interest  
The best measure to test relative stability of pre-  
corneal tear film is the tear film break-up time  
(BUT)13. The tear break up time in patients with dry  
eyes is shorter and vice versa14. Typically > 10  
seconds and < 5 seconds are recognized as healthy and  
low respectively while between 5 to 10 seconds are  
considered as the marginal TBUT of an eye15.  
Nevertheless, the dryness of eye is due to damage or  
disease of one of the three layer of the tear film, and  
the most common disorder is the aqueous tear  
deficiency16.  
Authors declared no conflict of interest  
Authors’ Designation and Contribution  
Syeda Rushda Zaidi; Optometrist: Study design, Data  
analysis, review of literature.  
Ali Ayaz Sadiq; Assistant Professor: Study design,  
final review.  
Shua Azam; Optometrist: Data Collection, final  
review.  
Uzma Sattar; Optometrist: Data Collection, final  
review.  
Our primary focus was to discover whether there  
is a considerable reduction in tear film break up time  
by wearing soft contact lenses or not. Our results  
showed that reduction of tear film break up was  
observed as the duration of wearing contact lenses was  
increased. Similar results were found in the studies of  
Stapleton et al17, Rabia18 and Pili et al19. Decreased  
tear film stability as measured with tear film BUT  
occurs with long term use of contact lenses stability. In  
a recent study, ocular discomfort and other dry eye  
symptoms were present in contact lens wearers20. The  
reason might be the daily wearing time of soft contact  
lens induced hypoxia and caused disturbances in pre  
corneal tear film stability. In addition, soft contact  
lenses are made of hydrogel material, which can  
absorb water and other liquids in its structure leading  
to tear film instability21. However, in this study, the  
symptoms of dry eye were not present in any subject  
that may be due to the smaller sample size and further,  
their signs were observed for shorter duration.  
Samia Iqbal; Optometrist: Data Collection, final  
review.  
Huma Ejaz; Optometrist: Data Collection, final  
review.  
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CONCLUSION  
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Ethical Approval  
The study was approved by the Institutional review  
board/Ethical review board.  
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Effect of Soft Contact Lens Wear on Tear Film Breakup Time  
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