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MattiSeppänen

Eye Pain in Contact Lens Wearers

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.

Type of contact lens	Use
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.

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.

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

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

Inflammation	Symptoms and findings	Workup	Treatment
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

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]