Contemporary contact lenses, when considered in perspective, are remarkably effective; the remaining primary challenge, however, appears to be the relationship of the contact lens to the tear film. The number of contact lens wearers in the United States is no longer increasing, perhaps the result of discomfort which may occur initially, preventing contact lens wear, or which may develop over a period of years, resulting in termination of wear. Contemporary lenses can usually provide comfort if tear film integrity can be maintained. The environmental humidity is a critical component in the formation and thickness of the lipid layer for both the preocular and the prelens tear films, thus influencing tear film stability and evaporation. A common clinical observation is the gradual development of discomfort over 10 or more years of contact lens wear by patients who initially are totally asymptomatic. This discomfort, probably the result of compromise to the tear film occurring with age, frequently leads to discontinuation of contact lens wear. Intermittent discontinuation of contact lens wear may also occur as the result of seasonal discomfort when the relative humidity is low, or when the nature of the visual demand, as in extended VDT operation, inhibits blinking. The fragile tear film and its relation to contact lenses is readily understood by two quotations: "The human tear film is rather unstable, but it is regenerated by frequent blinking", and "When a contact lens is placed in the eye, the lens alters the normal structure of the tear film and affects its rate of evaporation.(ABSTRACT TRUNCATED AT 250 WORDS)