What is a common sign of excessive dryness in a soft contact lens wearer?

A common sign of excessive dryness in a soft contact lens wearer is punctate staining at the 3 o'clock and 9 o'clock positions of the cornea. This staining occurs due to the lack of sufficient moisture and lubrication for the contact lens and the cornea. When the tear film is inadequate, it can lead to areas of desiccation and irritation on the corneal surface, which then stain when observed during a slit lamp examination. This specific staining pattern often correlates with dryness because it signifies that the lens is not sitting properly on the eye or that the tear film is insufficient to keep the lens hydrated.

Increased tear production would not be a direct sign of excessive dryness; rather, it often signifies that the eye is attempting to compensate for the dryness. Vertical corneal striae are typically associated with other conditions, such as corneal edema or keratoconus, and do not specifically indicate dryness in the context of contact lens wear. A clear corneal surface suggests that there is no significant irritation or dryness occurring, which would contradict the conditions that lead to punctate staining. Thus, punctate staining at the 3 and 9 o'clock positions is the most indicative sign of excessive dryness in soft contact lens wearers.