OVERVIEW: Cecelia Koetting, OD, FAAO, Dipl. ABO, and Julie Poteet, OD, MS, CNS, FOWNS, discuss contact lens discomfort and dropout as ocular-surface problems and outline a systematic approach to improving comfort, retention, and satisfaction by identifying and treating dry eye disease.

KEY POINTS: Contact lens discomfort is described as the leading cause of dropout, affecting an estimated 12% to 51% of wearers, with dry eye disease as the primary underlying driver. Evaporative dry eye, predominantly associated with meibomian gland dysfunction (MGD), accounts for at least 86% of cases in clinic-based cohorts. Screen use reduces blink rate and increases incomplete blinking, accelerating tear-film evaporation and MGD progression.

CLINICAL APPROACH: The authors recommend vital-dye staining and meibomian gland evaluation before contact lens fitting. Repeatedly changing lens brands or materials without treating the ocular surface does not restore tear-film stability. Where needed, patients may require three to six months of ocular-surface treatment before committing to a lens modality, with end-of-day comfort assessed alongside vision.

CONCLUSION: Contact lens dropout should be addressed by stabilizing the ocular surface first and fitting the lens afterward. Earlier identification and treatment of MGD, corneal staining, and screen-related blink dysfunction may improve comfort, retention, and patient satisfaction.