Clinical Scorecard: Contact Lens Practice Pearls: Keep TABS on Lens Awareness
At a Glance
| Category | Detail |
|---|---|
| Condition | Contact lens awareness, a symptom that may result from mechanical interaction between the lens and lid, lens-surface failure, or an ocular-surface problem exposed by lens wear; mechanisms may coexist. |
| Key Mechanisms | Mechanical interaction between the lens and lid, lens-surface failure, or an ocular-surface problem exposed by lens wear; mechanisms may coexist. |
| Target Population | Contact lens wearers reporting discomfort or awareness of the lens |
| Care Setting | Pretesting and slit-lamp evaluation, as described in the article |
Key Highlights
- TABS stands for timing, asymmetry, blink, and stop (what happens after lens removal).
- Immediate, constant discomfort points toward a mechanical cause; gradual increases in discomfort point toward a surface problem.
- Unilateral symptoms prompt evaluation for a lens defect, deposits, conjunctival elevation, asymmetric fit, corneal irregularity, or lid differences.
- Blink-related relief suggests that blinking is resurfacing the lens and points toward a tear-film problem; discomfort during blinking may indicate lid interaction with an edge, deposit, or area of lens standoff.
- Relief after lens removal suggests the lens is involved; persistent rawness after removal may indicate underlying surface disease.
Guideline-Based Recommendations
Diagnosis
- Ask about symptom timing, whether symptoms are unilateral or bilateral, the effect of blinking, and what happens after lens removal.
- Use TABS to direct the initial slit-lamp evaluation; it does not replace the rest of the workup.
- Consider lissamine green staining of the lid margins before placing another lens when evaluating suspected lid-related causes.
Management
- Identify the likely mechanism before selecting a response; the article notes that each mechanism requires a different response.
- Evaluate lens fit near the end of the day when a tight lens is suspected, because it may be comfortable early and symptomatic later.
Monitoring & Follow-up
- Have a trained paraoptometric ask and document the four TABS questions during pretesting before the practitioner enters the room.
Risks
- Repeated refitting or changing lens type may not resolve discomfort caused by lid interaction with a lens edge or underlying surface disease.
- Poor surface wetting can raise friction and produce a mechanical symptom.
Patient & Prescribing Data
Contact lens wearers with discomfort, including patients whose symptoms persist despite prior refitting.
The article describes a diagnostic approach rather than a specific treatment regimen. The author states that a new lens design will not resolve the described lid interaction with a lens edge; underlying surface disease requires a different response.
Clinical Best Practices
- Localize the likely mechanism before selecting a response.
- Use unilateral versus bilateral symptoms to guide examination of the lens, fit, lids, cornea, and ocular surface.
- Assess whether blinking improves or worsens symptoms and whether discomfort resolves after lens removal.
- Recognize that more than one mechanism may contribute to lens awareness.
Related Resources & Content
This content is an AI-generated, fully rewritten summary based on a published scholarly article. It does not reproduce the original text and is not a substitute for the original publication. Readers are encouraged to consult the source for full context, data, and methodology.