Contact lenses are gaining more popularity than ever, with millions of people around the world adopting them for daily use. However, just like any medical procedure, they come with complications. We spoke with Dr. Jeffrey Walline, a prominent optometrist at the Ohio State University College of Optometry, to discuss the risks of eye infections and trauma when using contact lenses, as well as measures to prevent them from happening.
From a scientific point of view, contact lenses have a relatively short history. But ever since the modern iteration’s widespread introduction to the ocular health industry in the 1970s, their popularity has only continued to grow.
Today, there is a plethora of contact lens options available on the market for different purposes. There are lenses designed for purely aesthetic reasons and some that can permanently correct vision without laser intervention. And in the near future, lenses that facilitate drug delivery are next in line to take off.
There are up to 140 million users of contact lenses worldwide, a number that continues to increase.1 Optometrists encounter many contact lens wearers on a daily basis, and no doubt must deal with some of the complications that can occasionally arise from contact lens usage.
While contact lenses are generally safe to use, there will always be a risk of complications and other negative side effects. Fortunately, most of these complications can be easily avoided with patient compliance.
Despite their immense popularity, however, contact lenses are still not used correctly by many patients, leading to an increased risk of numerous health issues, ranging from minor to eyesight-threatening complications. Some of the most well-known complications include various corneal problems, such as epithelial edema, micro-cysts, abrasions, conjunctival issues like allergic conjunctivitis, giant papillary conjunctivitis, and superior limbic keratoconjunctivitis.1,2
Nip infection in the bud
Dr. Jeffrey Walline, associate dean of research and a professor at the Ohio State University College of Optometry, has decades of experience working in optometry. He has treated patients affected by contact lens complications, both common and rare.
According to Dr. Walline, contact lens complications are an important issue that should be more widely recognized, especially since most cases are entirely avoidable.
“Most contact lens complications are very minor and include dry eye and eye redness. However, some complications can be devastating to the patient. Poor compliance with contact lens care can lead to an eye infection, causing severe pain and potentially permanent vision loss,” Dr. Walline said.
“Generally, people can avoid severe complications by following the doctor’s advice and calling the doctor if the eye becomes painful or red, or if they experience unclear vision. Even the most severe problems can be alleviated with quick treatment,” he continued.
Beyond mere eye infections
Eye infections in particular concern Dr. Walline, as they can cause some of the most serious problems for patients, including vision loss. One of the most severe of these infections is superior limbic keratoconjunctivitis, a hypersensitivity reaction to thimerosal or other preservatives in contact lens solutions, which usually present bilaterally and asymmetrically. Some of the most common symptoms that align with those listed by Dr. Walline above include pain, redness, and foreign
body sensation.3
Then there’s the more common complication, allergic conjunctivitis, which has been reported with thimerosal-containing lens solutions. Patients experience pain, redness, itching, and burning sensations in a reaction that usually develops days to months following exposure to thimerosal. Upon examination, clinicians usually find conjunctival hyperemia and the papillary response of the conjunctiva. Steroid eye drops should be used in tapering doses to prevent this reaction.4
“Eye infections can lead to extreme pain and may lead to permanent vision loss. While the pain is temporary, the front of the eye is the most sensitive place on the entire body, so the pain associated with an eye infection is extremely debilitating. The infection can lead to scarring of the cornea, the clear window on the front of the eye,” Dr. Walline explained.
“If the cornea becomes scarred, then it can lead to blurry vision—even while wearing glasses or contact lenses. Most of these complications can be avoided by not allowing tap water to touch the contact lenses, by avoiding sleep while wearing contact lenses, and by immediately contacting the eye doctor. If a patient’s eyes are red, painful, or can’t see, they should remove their contact lenses,” he said.
The pros of disposables
Dr. Walline’s instructions above for preventing complications related to contact lens usage might seem clear and straightforward.
But let’s face it, there’s always that one patient who’ll never listen no matter how much one may try. In cases like this, ODs can recommend the option of switching to daily disposable contact lenses instead, as these have been associated with a reduced number of complications.
“Daily disposable contact lenses have been shown to result in the fewest complications. Although they may be more expensive than contact lenses that are thrown away every two or four weeks, when you consider the cost of solutions and cases for these lenses, the difference in cost is typically worth the added convenience, comfort, and health benefits,” Dr. Walline said.
Dr. Walline’s preference for daily disposable lenses is supported by scientific research. Abrasions caused by trauma or mechanical injury due to the lens, insertion, or removal of the lens can result in corneal scarring, which also increases the risk of infection. Superficial punctate keratitis can also occur due to mechanical injury from the lens or during lens application. So can fungal keratitis and several other conditions associated with long-term wear of contact lenses.
Discarding lenses before bedtime
There’s one more piece of advice from Dr. Walline, albeit a very important one: Don’t sleep with your contact lenses on!
This is likely the single most dangerous practice that leads to complications, and one that can be easily avoided. Optometrists must thus make sure to consistently emphasize this to their patients.
“Patients must be continually reminded to avoid sleeping with their contact lenses on, as this may not only result in discomfort but also increase the risk of an eye infection tenfold. Patients should also schedule routine eye care appointments to proactively address any issues, rather than waiting until they start affecting vision or comfort,” concluded Dr. Walline.
References
- Gurnani B, Kaur K. Contact Lens-Related Problems and Complications. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023
- Wan SJ, Kroken AR, Nieto V, et al. Contact lens-related corneal infection: Intrinsic resistance and its compromise. Prog Retin Eye Res. 2020;76:100804. [Epub 2019 Nov 20]
- Bradley CS, Sicks LA, Pucker AD. Common Ophthalmic Preservatives in Soft Contact Lens Care Products: Benefits, Complications, and a Comparison to Non-Preserved Solutions. Clin
Optom (Auckl). 2021;13:271-285. - Singh RB, Liu L, Anchouche S, et al. Ocular redness – I: Etiology, pathogenesis, and assessment of conjunctival hyperemia. Ocul Surf. 2021;21:134-144. [Epub 2021 May 16]
Editor’s Note: This article was published in COOKIE magazine Issue 13.
