ArticleBMC ophthalmology2026
Eyelid and tear-film factors associated with contact lens discomfort symptom burden among wearers attending after-care in Kisumu County, Kenya: a clinic-based cross-sectional study.
Article in BMC ophthalmology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundContact lens discomfort (CLD) is a major cause of reduced wearing time and discontinuation of contact lens wear. However, many wearers continue using contact lenses despite persistent symptoms, and evidence from sub-Saharan Africa on the clinical correlates of symptom burden remains limited. This study examined associations between routinely assessed eyelid and tear-film characteristics and CLD symptom burden among contact lens wearers attending after-care in Kisumu County, Kenya.
methodsThis clinic-based cross-sectional study included 118 contact lens wearers attending after-care services in Kisumu County. CLD symptom burden was measured using the continuous Contact Lens Dry Eye Questionnaire-8 (CLDEQ-8) total score. Univariable and multivariable linear regression models with HC3 heteroscedasticity-robust standard errors estimated mean differences in CLDEQ-8 scores. The adjusted model included age, sex, blink rate, Schirmer's test, tear breakup time (TBUT), lid-parallel conjunctival folds (LIPCOF; ≥2 vs. 0-1 folds), and meibomian gland function. A sensitivity analysis used the established CLDEQ-8 threshold of ≥ 12 as a binary outcome.
resultsThe mean CLDEQ-8 score was 17.2 (SD 6.3). In univariable analysis, participants with ≥ 2 LIPCOF folds had CLDEQ-8 scores 3.28 points higher than those with 0-1 folds (95% CI 0.94 to 5.62; p = 0.007). The association remained after adjustment (mean difference 2.92 points, 95% CI 0.50 to 5.33; p = 0.018). Blink rate, Schirmer's test, TBUT, and meibomian gland function showed no clear adjusted associations with symptom burden. Excluding TBUT from the model produced an essentially unchanged LIPCOF estimate. In the binary sensitivity analysis, no factor was independently associated with a CLDEQ-8 score ≥ 12. The LIPCOF estimate attenuated in an exploratory model additionally adjusting for lens type and wearing characteristics.
conclusionsGreater LIPCOF was associated with higher CLDEQ-8 symptom burden in the primary analysis, whereas blink rate and routine tear-film measures showed no clear independent associations. LIPCOF may provide useful supplementary information during contact lens after-care but should not be interpreted as a standalone marker of discomfort. Structured symptom assessment should remain central, and longitudinal studies are needed to clarify directionality and the influence of lens and wearing characteristics.
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