EyeTools Optometry Skills

258: Binocular vision symptoms and contact lenses

Many of my myopic patients who wear contact lenses complain of what sounds like dry eye symptoms, but on examination I can find no evidence of dry eye. What is going on?

Discomfort symptoms of dry eye are similar to symptoms associated with binocular vision and accommodative disorders.

Symptoms like blurry/variable vision, end of day fatigue, and eyestrain are reported by people who suffer from dry eye or binocular vision and accommodative disorders.

Myopic people have increased accommodative and vergence demands when they wear their contact lenses compared to when they wear their spectacles.

It is important to remember that around one third of the adult population has a binocular vision or accommodative disorder.

It is very quick and easy to check for a binocular vision abnormality in uncomfortable contact lens wearers. A simple screening with cover test at distance and near, near point of convergence evaluation, and/or aligning prism will uncover signs that vergence or accommodative strain may be contributing to symptoms of discomfort.

It is important to find out if the patient’s symptoms are caused by a binocular vision anomaly since time and money can be wasted treating what sounds like dry eye and/or changing contact lens material or wearing modality.


Submit a Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

If you like EyeTools Questions of the Day…

Children’s Eye Examinations
How to Run a Successful Low Vision Clinic
How to Run a Successful Optometry Practice

Get EyeTools Journal : 80+ Expert Optometry Tips & Skills, 3x Weekly!



– Optometry students
– Pre-registration and novice optometrists
– Optometrists returning to work
– Junior eye doctors
– Dispensing opticians and orthoptists preparing for refraction exams
– Contact lens opticians, clinical assistants and eyecare educators

Improve your optometry skills with introductory & specialist instruction videos, topical live & recorded expert webinars, presentations and book reviews.

Start with the first section, ‘Pre-refraction procedures’ free, then choose a monthly or yearly subscription. To see English captions, click the CC button on any video.