Contact Lens Care: Getting a Clear Picture

Patients who wear contact lenses must be made aware that improper lens care and maintenance may lead to many serious ophthalmic problems.

Many individuals elect to wear contact lenses because of their comfort and ease of use as well as to avoid the disadvantages of wearing eyeglasses, which include fogging of lenses during changes in temperature and humidity, accumulation of dirt on lenses, and obstruction of vision by eyeglass frames.^1,2

It is imperative for contact lens wearers to be aware that improper lens care and maintenance may lead to many serious ophthalmic problems, such as greater incidence of corneal infection, corneal ulcers, and other ophthalmic disorders that may result in vision issues, permanent eye damage, and, rarely, blindness3 (Table 1^2,4-7).

According to the American Academy of Ophthalmology, keratitis is the most common infection related to contact lens use.3 In severe cases, keratitis may lead to corneal scarring that impairs vision, possibly requiring a corneal transplant.³ In addition to improper care of contact lenses, other factors that may increase the incidence of contact lens—related infections include use of extended-wear lenses, sleeping while wearing contact lenses, decreased tear exchange under the lens, poor hygiene, and environmental factors.³

Fortunately, several nonprescription products are available to aid patients in proper contact lens care. The goals of proper lens care include disinfecting the lens to prevent infection, removing debris from the surface of the lens, and preventing accumulation of protein on the tear layer of the contact lens.¹ Pharmacists can be instrumental in assisting contact lens wearers in selecting appropriate lens care products. Products formulated for soft contact lens care include surface-active cleaners, chemical disinfecting solutions, hydrogen peroxide disinfecting solutions, preserved saline solutions, enzymatic cleaning products, preservative-free saline solutions, and rewetting/lubricating solutions, as well as multipurpose solutions that act as surface-active cleaners, protein removers, and disinfectants.¹

Pharmacists can be key in identifying patients who may be at risk for drug—contact lens interactions.¹ These interactions may occur with the use of topical ophthalmic drugs and with many systemic drugs, some of which are secreted in tears.¹ Many other pharmacologic agents may alter tear production, the shape of the cornea, the lens or its refractive properties, or pupil size¹ (Online Table 2^1,8).

Table 2: Drug—Contact Lens Interactions

Drugs that may cause changes in lens color (primarily occurs with soft contact lenses):

• Diagnostic dyes
• Nicotine
• Phenylephrine
• Phenazopyridine
• Rifampin
• Sulfasalazin
• Tetracycline
• Topical tetrahydrozoline

Drugs that may cause pupil dilation:

• Anticholinergic agents
• Antidepressants
• Antihistamines
• Central nervous system stimulants

Drugs that may cause a decrease in tear volume:

• Anticholinergic agents
• Antihistamines
• Beta blockers
• Benzodiazepines
• Botulinum toxin type A (Botox)
• Conjugated estrogens
• Diuretics
• Oral contraceptives
• Serotonin reuptake inhibitors
• Statins
• Timolol (topical)
• Tricyclic antidepressants

Drugs that may cause an increase in tear volume:

• Cholinergic agents
• Dietary garlic supplements

Drugs that may cause lid/corneal edema:

• Clomiphene
• Conjugated estrogens
• Oral contraceptives

Drugs that may cause ocular irritation or inflammation:

• Diclofenac (topical ophthalmic)
• Garlic dietary supplements
• Gold salts
• Isotretinoin
• Salicylates

Drugs that may cause induction of myopia (changes in refractivity):

• Acetazolamide
• Sulfadiazine
• Sulfamethoxazole

Drugs that may cause miscellaneous interactions:

• Opiates (may cause papillary miosis)
• Digoxin (may increase glare)
• Hypnotics, sedatives, muscle relaxants (may decrease rate of blinking)
• Topical ciprofloxacin/prednisolone acetate (may result in precipitate)

Adapted from references 1 and 8.

During counseling, patients should be reminded (1) that proper lens care and storage are critical to preventing eye infections and other ophthalmic problems and (2) to only use products recommended for their type of contact lenses (Online Table 3^1,4-7). In addition, patients should be counseled to remove lenses before instilling any ophthalmic products not specifically intended for concurrent use with soft contact lenses and to wait at least 20 to 30 minutes before reinserting the lenses, unless otherwise directed by an eye care provider.¹ The use of contact lenses should be avoided when a topical ophthalmic ointment is being used or in the presence of irritating chemicals or fumes.¹ Patients should be advised to remove their contact lenses and immediately seek medical care to prevent complications if they experience any problems such as improperly fitting lenses, pain, redness, blurry vision, excessive tearing, increased sensitivity to light, discharge from the eye, or any signs of infection.^1,4-7

Table 3: Proper Contact Lens Care

• Before handling contact lenses, always wash your hands with warm water and soap to decrease the incidence of infection.

• Clean and disinfect your contact lenses according to the manufacturer’s instructions.

• Do not use saline solution or rewetting drops to disinfect contact lenses because these products are not effective or approved disinfectants.

• If your eyes become red or irritated or your vision changes, immediately remove your contact lenses and seek medical care.

• Always adhere to the directions of your eye care professional and maintain routine eye care appointments.

• Only use contact lens care products and solutions recommended by your eye care professional.

• Never use expired contact lens solutions.

• While wearing contact lenses, avoid wearing oily cosmetics.

• Only use sterile saline solutions for rinsing contact lenses. Do not use these solutions for cleaning and disinfecting your lenses. Never reuse contact lens solutions.

• Never rinse or store contact lenses in tap or sterile water.

• Never use your saliva to rewet your lenses.

• Clean, rinse, and dry your lens case with fresh solution each time you remove your contact lenses. Cases can become a source of bacteria.

• Always keep your contact lens care products in their original containers to help maintain the sterility of these products.

• Replace your contact lens storage case every 1 to 6 months or if it becomes cracked or damaged.

• Replace your contact lenses as needed, and note the expiration date of your contact lenses.

Adapted from references 1, 4-7.

More information on the proper care of contacts can be found on the American Academy of Ophthalmology website: www.geteyesmart.org/eyesmart/glasses-contacts-lasik/contact-lens-care.cfm.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References

• Russo P, Gaynes B, Engle J. Prevention of contact lens—related disorders. In: Krinsky DL, Berardi RR, Ferreri SP, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2011.
• Fast facts. Centers for Disease Control and Prevention website. www.cdc.gov/contactlenses/fast-facts.html. Accessed March 27, 2014.
• Contact lens—related eye infections. American Academy of Ophthalmology website. www.geteyesmart.org/eyesmart/diseases/contact-lens-related-infections.cfm. Accessed March 27, 2014.
• Contact lenses. Eye Care America website. www.aao.org/eyecare/treatment/contact-lenses/index.cfm. Accessed March 27, 2014.
• Tatham AJ. Contact lens removal. Medscape website. http://emedicine.medscape.com/article/1413506-overview#a01. Accessed March 27, 2014.
• Protect your eyes. Centers for Disease Control and Prevention website. www.cdc.gov/contactlenses/protect-your-eyes.html. Accessed March 27, 2014.
• Everyday eye care. FDA website. www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/ContactLenses/ucm062594.htm. Accessed March 27, 2014.
• Harman R. Contact lens care. In: Handbook of Pharmacy Education. 2nd ed. London, UK: Pharmaceutical Press; 2001.