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Eye Pain in Contact Lens Wearers

Essentials

  • A contact lens is a lens placed on the cornea to correct a refractory error or to treat superficial eye diseases.
  • If a contact lens wearer presents with a red, painful eye, always suspect keratitis or a lens remaining in the eye.
    • Use fluorescein staining to detect keratitis, and refer the patient to an ophthalmologist as an emergency. Keratitis in a person using contact lenses may threaten vision.
    • Evert the upper eyelid and check whether a contact lens or piece of a lens remains underneath.
  • A contact lens may also cause allergic blepharitis.

Types of contact lenses

  • See Table T1.

Types of contact lenses and their use

Type of contact lensUse
Soft
  • Most common lens type
  • Disposable contact lenses: usage time one day
  • Short-term contact lenses: usage time about 1 month
  • Long-term contact lenses: usage time about 6 months
Hard
  • Oxygen-permeable (RGP, i.e. rigid gas permeable) contact lenses
  • Can be used if soft contact lenses cannot correct an asymmetric refractory error or if soft lenses are contraindicated.
  • Fitting such lenses is more demanding than fitting soft contact lenses, and it will take more time to get used to them.
  • Usage time longer than for soft contact lenses
Specific-purpose lenses
  • Astigmatism: toric soft contact lenses
  • Presbyopia: multifocal contact lenses
  • For example, treatment of abnormal structures in the anterior eye, such as aniridia or sequelae of eye injuries
  • Special lenses for the treatment of dry eye
  • Special lenses for the treatment of keratoconus
  • Coloured contact lenses for changing the colour of the iris
Source: Uusitalo H. [Contact lenses]. In: [Handbook of ophthalmology]. Duodecim Publishing Company Ltd 2022.
Starting to use contact lenses, and checkups
  • Before starting to use contact lenses, the eye should be examined by an optometrist or ophthalmologist.
  • Instructions for careful hygiene and for the use of contact lenses should be provided when their use is started.
  • The superficial eye structures should be checked in association with checkups.

Risk factors for problems associated with the use of contact lenses

  • Swimming when wearing contact lenses will predispose the person to eye infections, particularly to the severe acanthamoeba keratitis. The risk is increased when swimming in natural waters or inadequately maintained pools.
  • Environmental dust and dirt may accumulate on the contact lens, predisposing the patient to eye inflammation.
  • Eye drops with vasoconstrictive effects to reduce redness must not be used with contact lenses.
  • Contact lenses should primarily not be worn while using medicated eye ointments or drops.
    • Preservative-free eye drops instilled 15 min before placing the contact lens can be used to treat glaucoma as prescribed by an ophthalmologist.
    • Preservative-free moisturizing eye drops can be used with contact lenses for mild eye dryness.

Eye symptoms in contact lens wearers

  • Use fluorescein staining to detect keratitis, and refer the patient to an ophthalmologist as an emergency.
    • Inflammatory alteration of the corneal surface can be seen under blue light.
  • Evert the upper eyelid and check whether a contact lens or a part of a lens remains in the eye.
  • Identify allergic blepharitis in a contact lens wearer. Eversion of the upper eyelid will help to identify giant papillary conjunctivitis Allergic Conjunctivitis.
  • Symptoms suggestive of eye inflammation
    • Pain
    • Reduced visual acuity
    • Redness
    • Itching
    • Foreign body sensation
  • For symptoms and findings, see Table T2

Workup

  • Fluorescein staining
  • Eversion of the upper eyelid
  • Examination of visual acuity
  • Intraocular pressure measurement
  • Taking microbial samples, as necessary
  • Ophthalmoscopic examination of the ocular fundus through dilated pupil

Treatment

  • A contact lens or a part of a lens remaining under the eyelid
    • Use anaesthetic eye drops (oxybuprocaine) to anaesthetize the eye. Evert the upper eyelid using a cotton-tipped swab. Examine the inside surface of the eyelid using a magnifying loupe or ophthalmoscope. Use a cotton-tipped swab or blunt tweezers to remove any contact lens remaining under the eyelid. Be careful not to touch the corneal surface.
  • For dry eye syndrome, see Dry Eye Syndrome
  • For the treatment of eye inflammation associated with the use of contact lenses, see Table T2

Eye inflammation associated with the use of contact lenses

InflammationSymptoms and findingsWorkupTreatment
Keratitis Keratitis
  • Pain
  • Redness
  • Reduced visual acuity
  • Watering or eye discharge
  • Fluorescein staining of the cornea
  • Microbial samples in specialized care
  • Emergency referral to an ophthalmologist
  • Pause the use of contact lenses as long as the eye is inflamed
  • After the pause, replace contact lenses with fresh lenses
Allergic blepharitis Blepharitis
  • Itching
  • Redness
  • Eversion of the upper eyelid
  • If symptoms continue despite treatment and pausing the use of contact lenses, test for allergies, consider brush cytology sample
  • Antihistamine eye drops twice daily for 2-4 weeks and subsequently as necessary
  • Oral antihistamine as an alternative to antihistamine eye drops
  • Sodium cromoglycate eye drops twice daily for 2-4 weeks
  • Pause the use of contact lenses as long as the eye is inflamed
  • Short-term use of glucocorticoid drops as prescribed by an ophthalmologist, as necessary
Bacterial conjunctivitis Conjunctivitis
  • Conjunctival erythema
  • Eye discharge
  • Reduced visual acuity
  • Microbial samples from the conjunctiva if symptoms persist despite treatment
  • Antimicrobial medication; drops during daytime and ointment for the night
  • Pause the use of contact lenses as long as the eye is inflamed
  • After the pause, replace contact lenses with fresh lenses

Other problems associated with the use of contact lenses

  • Dry eyes
    • A common symptom
    • In mild dryness of the eyes, use of contact lenses can be facilitated by using preservative-free moisturizing eye drops.
    • In severe cases, dry eyes are a contraindication to the use of ordinary contact lenses.
    • Special contact lenses have been developed for the treatment of dry eyes. Their use requires special skills from both the doctor prescribing them and the optometrist providing the treatment.
  • Redness and itching of the eyes
    • Often a sign of an allergic reaction to environmental allergens or to the contact lens material
    • May also be associated with dry eyes.
    • Moisturizing, preservative-free eye drops may reduce the symptoms.
    • Preservative-free sodium cromoglycate drops can also be considered during the use of contact lenses.
    • Therapeutic, medicated contact lenses have been developed for treating allergic symptoms.
    • Antihistamine drops should not be used concomitantly with contact lenses.

Differential diagnosis

    References

    • Chalmers RL, Wagner H, Mitchell GL et al. Age and other risk factors for corneal infiltrative and inflammatory events in young soft contact lens wearers from the Contact Lens Assessment in Youth (CLAY) study. Invest Ophthalmol Vis Sci 2011;52(9):6690-6. [PubMed]
    • Kari O, Teir H, Huuskonen R ym. Tolerance to different kinds of contact lenses in young atopic and non-atopic wearers. CLAO J 2001;27(3):151-4. [PubMed]

Related Keywords

ATC Code:

S01GX05

S01AA01

S01AA02

S01AA10

S01AA12

S01AA13

S01AA26

S01AA27

S01AA30

S01AX15

S01GX01

Primary/Secondary Keywords