The last several years you may have seen contact lens solutions recalls due to serious eye infections. This occurred on several different occasions with different brands of solutions. After extensive research, it was found there were no cases of lens contamination. The problems came from incorrect use of the solutions and poor contact lens care hygiene practices. In making solutions easier to use and improving their comfort enhancing capacities there is less tolerance for not using them in the intended manner.
Some simple tips can go a long way in keeping your eyes healthy and preventing serious eye infections. These infections are referred to as microbial keratitis when they infect the surface of the cornea, the clear tissue on the front of the eye. When they actually invade the cornea and start to destroy inner layers they are known as corneal ulcers. While corneal ulcers can be due to viruses and fungus, most contact lens related infections are caused by bacteria. Some aggressive strains of bacteria, such as Pseudomonas, can literally perforate an eye overnight if not treated early. While this is rare and contact lenses are generally very safe, the following steps can help prevent many problems from ever starting.
* Always, always wash your hands before handling lenses. This means both before putting them in and before removing them.
* Wash your hands long enough and all over including nails and finger tips with soap and water. In our optometry office we suggest about as long as it takes to sing the happy birthday song twice (10 seconds).
* It is helpful to put a clean paper towel on the counter to lessen contamination in case you drop the lens. Ideally this would be sterile and lint free, but practically speaking a clean towel is a vast improvement over the bathroom counter. If there is any question about a contaminated surface (yes that bathroom counter and floor is teaming with bacteria) the lenses should be put through a complete disinfection cycle prior to wearing. Disinfection cycle times vary by manufacturer but most require a minimum of 6 hours.
* Rubbing your lenses daily with the proper solutions is important to clean the biofilm of debree and coatings that build up on your lenses. Removing this coating allows the disinfectant properties of the contact lens solution to act on the lens surface. For a number of years eye doctors have been dispensing no rub solutions since compliance was so much higher. The no rub label is rapidly disappearing on contact lens bottles as we learn more about how people skip steps and inappropriately care for their contacts. It probably disappeared from the labeling of the same solution you have been using for years that had large no-rub prominently printed on it in the past.
* After rubbing the lenses you need to adequately rinse them with solution. Read the directions on the bottle. Most people don’t use anywhere near enough solution in rinsing. Inadequate rinsing is a proven cause of bacteria growth.
* Close the cap on that bottle of solution. Sitting around all day open allows potential bacteria to enter the bottle, especially if it is knocked over and contacts a countertop. Yes it is confusing since the solution is designed to kill bacteria, but overloading the solution with bacteria can create an environment that exceeds the kill capacity. Squirt out the first few drops before using in case it has been sitting in the nozzle, especially for unpreserved saline spray solutions.
* Check the expiration date. It is even more important on opened bottles.
* Be very careful not to touch your eyelashes or eyelids with any drops you use with your contact lenses. Your eyes always have bacteria but the immune system normally keeps them in check. Don’t add to the problem by contaminating your rewetting eye drops. While you are checking expiration dates look at your makeup. It is highly unregulated and a great source of contamination. Throw away anything older than a few months.
* Remember that case you keep your contact lenses in that you got 6 years ago? It’s time to throw it out. You should be replacing your case every few months. While there is no consensus yet, probably monthly is a good idea. You can clean and disinfect cases but they all develop micro scratches and collect dirt where bacteria love to grow. While some people are concerned it is environmentally improper, consider how often you local hospital reuses individual patients items. Never, and for good reasons! You can often find bottles of solution packaged with cases at no additional charge.
*Tap water and especially hot tubs don’t mix well with contact lenses. Acanthamoeba is a very difficult infection to treat that like to live in hot tubs that haven’t been treated correctly or have just been overloaded by too many occupants. Bottled water is not necessarily sterile. Stick with contact lens solutions. Generic solutions may vary ingredients and most use older preservatives more likely to cause allergic reactions. Brand name solutions are more consistent and use large molecule preservatives that are safer and less toxic to eye tissues.
* Make sure you are using a disinfecting solution. Saline solutions are often much cheaper but have no value in killing bacteria. Ask your eye doctor for recommendations and don’t change without discussing it first. Some contact lens materials may not be compatible with certain solutions.
* Never, ever put your contacts in your mouth. Beside the obvious fact that they are lacking in taste you mouth is full of bacteria that don’t belong in your eye.
* So called “topping off solutions” has been attributed to many problems. This is when you reuse the solution in the case and keep adding to it like your windshield wiper fluid. That devastates it’s capacity to kill bacteria. You need to rinse the empty the case with solution every day and let it air dry in a clean place.
* Replace your lenses when you are told to. Disposable lenses greatly reduce infections when they are used as advised. Chances are you don’t wear one pair of socks for 6 months, why would you want to take that risk with your vision?
* Contact lenses should always be comfortable, your eyes should not be red or painful, and your eyesight should be clear. If one or all of these criteria are not true remove your lenses and contact your Optometrist. It is especially important if it is getting worse several hours after lens removal- this can be a warning sign of corneal ulcers.
Contact lenses are a very safe and excellent technology for correcting your vision. These tips are not intended to replace the advice and directions given to you by you eye care doctors office. Always consult your eye doctor for any advice in care and handling and follow the instructions they give you for a lifetime of healthy lens wear.
Dr. David Kisling is an Eye Doctor in Fort Collins, CO where he has been a contact lens specialist for the last 25 years at Harmony Eyecare.