Proper contact lens care is one of the most important patient education topics in ophthalmic practice. Poor lens hygiene is the primary risk factor for contact lens-related infections, including microbial keratitis, a potentially blinding complication. CPOs play a central role in teaching patients correct lens care practices.
Types of Lens Care Solutions
Multi-Purpose Solutions (MPS)
Multi-purpose solutions (MPS) are the most commonly used contact lens care products. They perform multiple functions in one bottle: cleaning, rinsing, disinfecting, and storing soft contact lenses. This convenience makes them popular with patients.
The correct MPS routine is:
- Wash and dry hands thoroughly before handling lenses.
- Place the lens in the palm and apply a few drops of MPS.
- Rub the lens gently for 20 seconds, even if using a "no-rub" solution. The rub step mechanically removes deposits and reduces microbial load far more effectively than rinsing alone.
- Rinse with MPS.
- Place in a clean lens case filled with fresh MPS. Do not top off (add new solution to old solution in the case).
- Replace the lens case monthly or as directed.
Hydrogen Peroxide Systems
Hydrogen peroxide (H2O2) systems provide superior disinfection compared to MPS, particularly for patients with sensitivity to MPS preservatives (especially PHMB and PAPB). The most common systems use 3% hydrogen peroxide, which is a potent oxidant that kills bacteria, fungi, and Acanthamoeba.
Critical points about peroxide systems:
- After placing lenses in the peroxide solution, a catalytic disc or tablet in the case neutralizes the hydrogen peroxide into water and oxygen over at least 6 hours.
- The lens must never be placed in the eye before neutralization is complete. Neutralized solution is safe; un-neutralized peroxide causes severe burning and corneal damage.
- Most peroxide cases are designed so the lens cannot be removed until the neutralization time has passed.
- Peroxide solution must never be used as a direct eye drop or rinse.
Lens Case Hygiene
The lens case is a major source of lens contamination. Proper case care includes:
- Rinse the case with fresh contact lens solution (not water) after each use.
- Allow the case to air dry face-down on a clean tissue.
- Replace the case monthly (most MPS products include a new case).
- Never rinse with tap water. Tap water can harbor Acanthamoeba, a rare but devastating cause of keratitis.
Water and Contact Lenses
Water (tap, pool, hot tub, lake) should never contact contact lenses. Water is not sterile and contains organisms including Acanthamoeba castellanii, which can bind to contact lenses and cause a rare but extremely painful and vision-threatening corneal infection called Acanthamoeba keratitis. Patients must remove lenses before swimming, showering, and using hot tubs.
Patient Education Summary
Key messages for every contact lens patient:
- Always wash and dry hands before handling lenses.
- Rub lenses with solution even if using "no-rub" products.
- Replace lenses on schedule; do not over-wear.
- Never use tap water, saliva, or eye drops not intended for contact lenses.
- Remove lenses before swimming, showering, or sleeping (unless specifically prescribed for overnight wear).
- Replace the lens case monthly.
- Report any redness, pain, or blurred vision immediately; do not wear lenses through discomfort.
Key Takeaways
- Multi-purpose solutions clean, disinfect, and store; always instruct patients to rub lenses even with "no-rub" formulas.
- Hydrogen peroxide systems provide superior disinfection; lenses must neutralize for at least 6 hours before insertion to prevent corneal burns.
- Never top off lens cases with old solution; empty, rinse, and refill with fresh solution each use.
- Tap water, pool water, and hot tubs carry Acanthamoeba risk; lenses must be removed before any water exposure.
- Monthly lens case replacement is essential to prevent biofilm accumulation and microbial contamination.