Common Handling Instructions for Soft Contact Lenses
Insertion & Removal Techniques | Do’s and Don’ts
Introduction
Proper handling of soft contact lenses is essential to ensure comfort, prevent contamination, and avoid ocular complications such as infections, corneal abrasions, and inflammation. Teaching patients the correct way to insert, remove, and care for lenses is as important as prescribing them. This topic outlines the standard procedures for lens insertion and removal, and the key do’s and don’ts that every wearer should follow.
1. Pre-Handling Hygiene
Before touching lenses, patients should always:
- Wash hands thoroughly with mild soap and water
- Dry hands using a lint-free towel (avoid tissues or cloths with fibers)
- Ensure fingernails are trimmed and smooth to prevent tearing lenses or scratching the eye
- Remove eye makeup before lens handling (if applicable)
2. Insertion Technique for Soft Contact Lenses
🔄 Step-by-Step Procedure
- Place the lens on the tip of your **index finger**, ensuring it's upright and not inside-out.
- Check lens shape: It should appear like a cup with straight vertical edges (not flared).
- Use your **middle finger** of the same hand to pull down the **lower eyelid**.
- Use the **index or middle finger** of the other hand to lift the **upper eyelid**.
- Look straight ahead or slightly upward and gently place the lens on the cornea (center of the eye).
- Blink slowly to allow the lens to settle into position. It may take a few seconds for clarity.
- Repeat the process for the other eye.
🧪 How to Check If a Lens is Inside-Out
- Correct position: Cup shape with smooth edges (U-shaped)
- Wrong position: Edges flare outward like a bowl (saucer-shaped)
- Tip: Squeeze test – a correct lens folds easily; an inverted one resists folding properly
3. Removal Technique for Soft Contact Lenses
🔄 Step-by-Step Procedure
- Wash and dry hands thoroughly before touching your eye.
- Look slightly upward and pull down the **lower eyelid** using the middle finger.
- With your index finger, slide the lens downward to the white part of the eye (sclera).
- Gently pinch the lens using your **thumb and index finger** and remove it.
- Place the lens in the case with fresh solution or discard it (for dailies).
💡 Tips for Easier Removal
- Use rewetting drops before removal if the eyes are dry
- Maintain short, smooth fingernails to avoid scratching
- Practice in front of a mirror with proper lighting
4. Do’s and Don’ts of Contact Lens Handling
✅ Do’s
- Wash hands before every lens handling
- Check lens for damage or debris before insertion
- Use recommended cleaning solutions — never reuse old solution
- Store lenses in a clean case and change case every 1–3 months
- Remove lenses before swimming or showering (unless doctor-approved)
- Follow the replacement schedule (daily, biweekly, monthly)
- Follow up regularly with your optometrist or ophthalmologist
❌ Don’ts
- Do not sleep with lenses unless they are approved for extended wear
- Do not rinse or store lenses in tap water or saliva
- Do not use expired lens solutions or wear expired lenses
- Do not apply makeup before inserting lenses
- Do not switch brands or solutions without professional advice
- Do not share your lenses with anyone
5. Patient Education and Communication
Every new wearer should be trained on:
- Lens insertion and removal demonstration (preferably supervised)
- Identifying warning signs: redness, pain, photophobia, blurred vision
- When to remove the lens and seek immediate professional help
- Proper cleaning and storage routine
📘 Sample Counseling Script
"If your eye becomes red, painful, or your vision becomes cloudy — remove the lens immediately and contact your eye care provider. Do not try to tolerate the discomfort. A small issue can become serious very quickly if ignored."
6. Common Handling Errors and Their Solutions
| Error | Cause | Solution |
|---|---|---|
| Lens folds or falls off during insertion | Hands not dry / lens not centered | Dry fingers and use index tip, not the pad |
| Difficulty removing lens | Dry lens / improper pinch | Use rewetting drops before removal |
| Lens feels uncomfortable | Lens inside out / debris on lens | Check orientation and rinse lens |
| Blurry vision after insertion | Lens misaligned / wrong eye | Reinsert lens, verify R/L sides |
7. Clinical Perspective
Many lens-related complications stem from improper handling rather than the lens material itself. Contact lens-induced microbial keratitis is most commonly associated with poor hygiene and overnight wear of daily lenses. Therefore, strict adherence to handling instructions is non-negotiable.
Recommended Follow-Up Schedule for New Wearers:
- First follow-up: 1 week after initial fitting
- Next: 1 month later
- Routine: Every 6–12 months depending on risk profile
Conclusion
Proper insertion, removal, and hygiene practices are the foundation of safe and successful contact lens wear. Teaching patients these techniques not only reduces the risk of complications but also empowers them to wear lenses confidently and comfortably. As an optometry student or practitioner, your ability to instruct and counsel patients thoroughly is critical for their long-term visual health and compliance.
References
- Bennett ES, Henry VA. Clinical Manual of Contact Lenses, 3rd Edition, Lippincott Williams & Wilkins, 2008.
- Phillips AJ, Speedwell L. Contact Lenses, 5th Edition, Butterworth-Heinemann, 2007.
- American Optometric Association (AOA) – Patient Handouts on Contact Lens Safety
- CDC Guidelines on Contact Lens Hygiene
Care and Maintenance of Soft Contact Lenses
Cleaning Agents, Rinsing Agents, Disinfecting Solutions, Lubricating & Enzymatic Cleaners
Introduction
Proper care and maintenance of soft contact lenses are essential for preserving lens quality, ensuring user comfort, and most importantly, preventing serious ocular infections. Neglecting these steps can result in complications such as corneal ulcers, conjunctivitis, microbial keratitis, and lens intolerance. This topic explains the functions and types of care systems, and their roles in daily lens hygiene.
1. The Importance of Lens Care
Every time a reusable contact lens is worn, it collects tear proteins, lipids, mucus, environmental debris, and microorganisms. Proper care achieves the following:
- Removes surface deposits (proteins, lipids)
- Kills or neutralizes bacteria, fungi, and Acanthamoeba
- Prevents lens damage or warping
- Maintains moisture and comfort
- Reduces risk of allergic and toxic reactions
2. Daily Lens Care Routine
- Wash and dry hands thoroughly
- Remove one lens and clean it with the recommended solution (rub and rinse)
- Place the lens in its correct case well
- Repeat for the second lens
- Fill both wells with fresh multipurpose solution or disinfectant
- Soak lenses overnight or as directed
- Rinse lenses before insertion
3. Types of Contact Lens Solutions
🔹 A. Cleaning Agents
These remove surface debris, protein, and lipid deposits from the lens. Even when labeled as “no-rub,” rubbing the lens increases cleaning effectiveness by up to 80%.
- Types: Surfactant cleaners, Multipurpose solutions
- Use: Place the lens in your palm, apply a few drops, and gently rub in a circular motion for 10–15 seconds
- Examples: Opti-Free PureMoist, Renu Advanced Formula
🔹 B. Rinsing Agents
These flush away debris and cleaning solution residue. They also rinse lenses prior to insertion to remove irritants.
- Use after cleaning and before wearing the lens
- Important: Only sterile, lens-approved solutions should be used for rinsing — never tap water
- Examples: Bausch + Lomb Renu Advanced, Sensitive Eyes Saline Solution
🔹 C. Disinfecting Solutions
Disinfectants kill or inactivate microorganisms (bacteria, fungi, protozoa). They are the most crucial part of lens care.
Types of Disinfecting Systems:
1. Multipurpose Solutions (MPS)
- All-in-one solution: cleans, rinses, disinfects, and stores
- Convenient and widely used
- Examples: Opti-Free Express, Biotrue, ReNu
2. Hydrogen Peroxide Systems
- Use 3% hydrogen peroxide for deep disinfection
- MUST be neutralized with a catalytic disc or tablet before insertion
- Effective against Acanthamoeba and biofilms
- Examples: Clear Care, AOSept Plus
3. Thermal Systems (Less Common)
- Use heat (60°C) for disinfection in specialized units
- Less convenient; rarely used today
⚠️ Warning:
Never mix solutions from different brands or reuse solution already in the lens case. Always empty and air-dry the case daily.
4. Lubricating Drops (Rewetting Agents)
These drops are used to maintain moisture and comfort during lens wear. They help prevent dryness, especially in digital device users or dry environments.
- Used while lenses are on the eyes
- Provide temporary relief from lens-related dryness
- May improve lens tolerance and wearing time
- Examples: Blink Contacts, Systane Hydration PF, Refresh Contacts
Note:
Always ensure rewetting drops are compatible with soft contact lenses. Avoid preserved or medicated drops unless prescribed.
5. Enzymatic Cleaners
These are specialty cleaning tablets or drops used weekly (or as needed) to remove stubborn protein deposits that cannot be cleared by daily cleaning.
- Especially useful in high-protein tear film individuals
- Soak lenses in solution mixed with enzyme tablet
- Rinse thoroughly before wear
- Examples: SupraClens, Opti-Free Enzyme Cleaner
6. Lens Case Hygiene
- Clean lens case with solution, not water
- Air-dry upside down with caps off
- Replace case every 1–3 months
- Label R and L wells clearly to avoid cross-contamination
7. Clinical Implications of Poor Lens Care
- Microbial Keratitis: Serious infection often caused by sleeping in lenses or poor hygiene
- Giant Papillary Conjunctivitis (GPC): Allergic response to protein deposits or preservatives
- Corneal Neovascularization: Caused by hypoxia from extended wear and protein buildup
- Lens warping or tears: From improper storage or cleaning techniques
8. Patient Education Checklist
- Demonstrate correct rubbing and rinsing method
- Explain storage instructions and case hygiene
- Stress importance of fresh solution every time
- Warn against using tap water, saliva, or expired solution
- Encourage regular eye check-ups to assess lens performance
Conclusion
Effective contact lens care goes beyond convenience—it is a vital health practice. A complete understanding of cleaning, rinsing, disinfecting, and lubricating agents ensures better lens performance and lowers the risk of complications. As a future eye care professional, it's your duty to educate every wearer about strict hygiene, appropriate solutions, and early recognition of adverse signs.
References
- Bennett ES, Henry VA. Clinical Manual of Contact Lenses, 3rd Edition. Lippincott Williams & Wilkins, 2008.
- Phillips AJ, Speedwell L. Contact Lenses, 5th Edition. Butterworth-Heinemann, 2007.
- American Optometric Association (AOA) Contact Lens Care Guidelines.
- Centers for Disease Control and Prevention (CDC): Lens Hygiene Recommendations.
Follow-Up Visit Examination for Soft Contact Lens Wearers
Introduction
Follow-up visits are a vital part of contact lens management. They allow the practitioner to evaluate the patient’s response to the lenses, monitor ocular health, check for early complications, and ensure proper lens hygiene and compliance. A successful lens fitting isn’t complete until the lens proves to be safe and effective over time. This article provides a detailed overview of what to examine and document during follow-up appointments for soft contact lens wearers.
1. Importance of Follow-Up Examinations
Even if the patient is symptom-free, regular follow-ups help:
- Detect early signs of inflammation, dryness, or infection
- Assess lens fit in real-world use (work, screen time, sports)
- Evaluate visual performance over extended wear
- Reinforce proper handling and hygiene techniques
- Modify lens parameters if needed
- Ensure compliance with replacement and cleaning schedule
2. Suggested Follow-Up Schedule
- Initial Follow-Up: 5–7 days after lens dispensing
- Second Follow-Up: After 1 month of regular wear
- Routine Checks: Every 6–12 months or as required
- High-risk Wearers: More frequent visits (e.g., extended wear, therapeutic use)
3. Pre-Examination History
Always start the follow-up with a brief history:
- Duration of daily wear and total wearing hours
- Any discomfort, dryness, redness, photophobia, or discharge
- Blurry or fluctuating vision
- How often lenses are replaced (compliance with modality)
- Which cleaning solutions are being used
- Any recent infections, allergies, or systemic medications
📌 Sample Questions:
- "How many hours do you wear your lenses each day?"
- "Do you experience any irritation or dryness towards the end of the day?"
- "When did you last replace your lenses and lens case?"
4. Clinical Examination Protocol
🔍 A. Visual Acuity (with and without lenses)
- Measure uncorrected and best corrected visual acuity
- Compare to baseline visit
- Check for over-refraction if VA is reduced
🔎 B. External Examination
- Check lids for inflammation, meibomian gland dysfunction
- Inspect the conjunctiva for injection, follicles, or papillae
- Evaluate tear meniscus height for dry eye signs
🧪 C. Slit Lamp Examination
- Examine cornea and limbus for:
- Neovascularization
- Staining patterns (use fluorescein dye)
- Microcysts, infiltrates, or edema
- Assess the contact lens:
- Centering and stability
- Edge interaction with conjunctiva
- Lens movement with blink
- Surface deposits or warping
🧴 D. Push-Up and Blink Tests
- Push-Up Test: Gently nudge lens upward to evaluate mobility and re-centering
- Blink Test: Observe post-blink movement and centration
📈 E. Fluorescein Assessment (after lens removal)
- Use fluorescein strip to stain cornea
- Observe under cobalt blue filter
- Detect punctate epithelial erosions or pattern-based staining (e.g., inferior arcuate from mechanical trauma)
5. Common Findings and Their Significance
| Finding | Possible Cause | Management |
|---|---|---|
| Lens Decentration | Incorrect base curve or small diameter | Change to steeper BC or larger lens |
| Conjunctival Redness | Solution allergy, dryness, lens edge irritation | Change solution, use lubricants, adjust fit |
| Corneal Staining | Mechanical trauma, tight lens, dryness | Refit lens, reduce wear time, manage dryness |
| Surface Deposits | Poor cleaning, expired solution, lens overwear | Emphasize hygiene, consider daily disposables |
| Lens Warping | Thermal damage or mechanical stress | Replace lens, review care method |
6. Patient Counseling and Education
- Reinforce correct handling, cleaning, and replacement
- Discuss lens-free time if signs of hypoxia or dryness appear
- Educate about recognizing early signs of complications
- Encourage rewetting drops if dryness persists
- Suggest switching to daily disposables if hygiene is poor
7. Documentation Checklist
- Lens brand, type, power, base curve, and diameter
- Wearing time per day and replacement schedule
- VA with lenses and over-refraction
- Fit findings (centration, movement, edge lift)
- Ocular health status (cornea, conjunctiva, lids)
- Plan for continued wear, modification, or discontinuation
Conclusion
Follow-up examinations are essential to the success of soft contact lens wear. They allow clinicians to monitor ocular health, ensure lens performance, and provide personalized guidance based on real-world lens wear. Regular, structured evaluations help detect complications early and improve patient confidence and compliance. Always treat the follow-up as an opportunity to educate, prevent, and optimize.
References
- Bennett ES, Henry VA. Clinical Manual of Contact Lenses, 3rd Edition, Lippincott Williams & Wilkins, 2008.
- Phillips AJ, Speedwell L. Contact Lenses, 5th Edition, Butterworth-Heinemann, 2007.
- Contact Lens Society of India (CLSI): Clinical Guidelines for Follow-Up
- American Optometric Association (AOA): Contact Lens Evaluation Protocols
