Red Eye in Contact Lens Wearers

Redness during or after contact-lens wear requires prompt attention. Possible causes include dryness, surface irritation, inflammation and infection of the cornea. These conditions cannot always be distinguished by symptoms or appearance alone.

The contact lens should be removed immediately. We recommend retaining the contact lens, case and solution, as these may be sent for microbiological examination to help identify a possible infective organism if necessary.

Pain, light sensitivity or reduced vision requires urgent same-day assessment because these symptoms may indicate corneal infection. This could represent a serious, potentially blinding eye condition.

Contact Lenses and the Cornea

The cornea is the transparent structure at the front of the eye. Its smooth, clear surface is essential for focusing light accurately.

A contact lens rests on the tear film covering the cornea. Contact lenses are generally safe when correctly fitted, worn and maintained.

Microbial keratitis is an infection of the cornea that can progress rapidly and requires urgent treatment. Examination is necessary to distinguish it from conjunctivitis and other less serious causes of redness.

The risk is greater when contact lenses are worn overnight, used beyond their recommended replacement period, exposed to water or handled without appropriate hygiene.

Indications for Urgent Same-Day Assessment

A contact-lens-related red eye should be assessed urgently on the same day when it is accompanied by:

• pain or increasing discomfort

• sensitivity to light

• blurred or reduced vision

• increasing redness

• excessive watering or unusual discharge

• a white or grey spot on the normally clear cornea

Persistent redness after the contact lens has been removed also requires prompt professional advice, even when discomfort is mild.

Clinical Examination

The examination usually includes measurement of visual acuity and assessment of the cornea with a slit-lamp microscope. Fluorescein dye may be applied to identify a corneal abrasion, epithelial defect or ulcer. The eyelids, conjunctiva and other structures at the front of the eye are also examined.

If microbial keratitis is suspected, a sample may be collected from the affected area of the cornea before treatment begins. The retained contact lens, case and solution may also be sent for microbiological examination. These investigations can help identify the causative organism and guide antimicrobial treatment.

Close follow-up may be required because corneal infection can change over a short period and treatment sometimes needs to be adjusted.

Contact Lens Care

All contact lens wearers need to be meticulous about washing and drying their hands before handling their lenses. Reusable lenses should be cleaned and stored using fresh disinfecting solution, and storage cases should be replaced as recommended.

Daily disposable contact lenses are associated with a lower risk of severe microbial keratitis than reusable weekly, fortnightly or monthly soft lenses. However, daily disposable lenses still require careful handling and must not be reused.

Contact lenses and solutions should be stored in a cool, dry place away from heat and direct sunlight. Reusable lens cases should be kept clean and dry, away from splashes and other sources of contamination, and should not be stored beside a toilet or bathroom sink.

Swimming, showering and sleeping while wearing contact lenses should be avoided. Contact lenses should never be rinsed or stored in tap water.

Regular contact-lens examinations should be scheduled and attended to assess ocular health, lens fit and wearing practices. Lubricating eye drops may be recommended when dry-eye symptoms occur.

Eye & Retina Specialists Sydney in Green Square/Waterloo assesses corneal and other eye conditions when specialist review is required. A contact-lens-related red eye associated with pain, light sensitivity or reduced vision requires urgent assessment on the same day.