Here at Associated Eye Care, Halloween is a big deal. Each year doctors and staff dress up in costumes vying for the coveted award of Best in Show. Last year it was a Hulk Hogan look-alike that took home top honors. It’s a fun day for patients and staff. However, there is a scary side to eye care around the time of Halloween – the improper use of over-the-counter cosmetic contact lenses. These lenses, which can be purchased without a prescription in convenience stores, novelty shops, or online, come in designs such as cat-eye, 8-ball, and zombie-white. Unfortunately, these lenses are not typically prescribed by eye care providers, but rather obtained illegally without a prescription.
Here is an example of a patient that came to our clinic one recent Halloween. A mother called stating that her daughter wore cosmetic lenses to school, and by midday, her eyes became painful and red. She did not remove her lenses, and in fact, was still wearing them when she presented to us after hours that evening. It was clear that her contact lenses were much too tight on her eyes, resulting in anoxia and inflammation of her corneas (Contact Lens Associated Keratitis). The lenses were removed, and antibiotic drops were started. Her acute symptoms resolved after a couple of days, but unfortunately, she ended up with some corneal scarring. This patient was lucky in that she had only worn the contacts for one day and sought care soon after her symptoms began. It is not uncommon for these patients to present much later in the course of their problem, with the results being significantly greater vision loss.
The most concerning part of this story is that the patient purchased these contact lenses at a gas station, with little more thought than purchasing a pair of cheap sunglasses. Contact lenses are recognized as Class II or III medical devices by the FDA, and they require a prescription from an optometrist or ophthalmologist in order for a patient to acquire them. As part of the fitting process at our office, the patient’s eye is measured, and then different contact lenses are trialed for fit, vision, and comfort. The patient will then wear their new contact lenses for a week or two and return for a final evaluation prior to receiving the prescription. We also instruct patients on the need to practice good hand washing and proper contact lens case hygiene to minimize infection risk. When purchasing cosmetic contact lenses over the counter as this patient did, none of these steps are undertaken, and the result is that patients usually end up with an improperly fitting lens.
The cornea is avascular and receives much of its oxygen from the air. Improperly fitting contact lenses disrupt the cornea’s access to oxygen and can lead to ischemia with resultant inflammation and possibly bacterial infection (corneal ulcer). Even though we are much better at treating these problems than we once were, patients with contact lens-related problems can still go on to develop irreversible vision loss, and may even require corneal transplantation for visual rehabilitation.
At this point, it is important to highlight a few other things that need to be considered for our contact lens patients. Contact lenses need to be replaced as scheduled. For the most part, contacts are designed for either monthly, biweekly, or daily replacement. Each lens type is designed to function appropriately only for its designated lifespan. Once the lenses go beyond this timeframe, they become more hydrophobic, are more irritating to wear, and most importantly have decreased oxygen permeability, thus making corneal ischemia more likely.
Sleeping in contact lenses is another risky activity that can lead to vision loss, and so should never be done. Even though some contact lenses have been approved to sleep in by the FDA, they carry an unacceptably high risk of problems, and so we recommend that patients never sleep in contact lenses. The reasoning here is simple. Because the eyes are closed continually for hours while asleep, the contact lenses will stick to the cornea causing microscopic trauma to the corneal epithelium. Also, contact lenses by their nature are sticky to bacteria. So, patients that sleep in their contact lenses are exposing a damaged epithelial layer to a bacteria-laden piece of plastic for hours on end – you can see how it is a set-up for disaster.
What should you do if you are interested in Contact Lenses?
We are pleased to offer contact lens services at Associated Eye Care. A Contact Lens Eye Exam is required prior to purchasing and can be scheduled by calling 651-275-3000.
