Proper contact lens care is one of the most impactful topics in paraoptometric practice. Poor hygiene habits are the leading cause of contact lens-related infections—many of which are preventable with thorough patient education. As a paraoptometric professional, you will reinforce lens care protocols daily, making this a core competency for both the CPO and CPOA certification exams.
Why Lens Care Is a Public Health Issue
The CDC estimates that roughly 1 million Americans develop contact lens-related eye infections each year, costing the healthcare system over $175 million annually. The vast majority of these infections are preventable. The most common risk behaviors include sleeping in lenses not approved for extended wear, topping off solution in the case instead of replacing it, using tap water, and not replacing lenses on schedule.
Paraoptometric staff are often the frontline educators who reinforce proper habits at every visit. Your ability to clearly explain the "why" behind each step—not just the rules—is what creates lasting behavioral change in patients.
Bacterial Keratitis
Most common serious complication; Pseudomonas and Staphylococcus most frequent pathogens.
Acanthamoeba Keratitis
Rare but devastating; linked to water exposure. Can result in permanent vision loss.
Fungal Keratitis
Less common; associated with organic matter exposure and lens trauma.
Giant Papillary Conjunctivitis
Immune reaction to lens deposits; causes itching, mucus, and lens intolerance.
The Six Steps of Proper Lens Care
Every patient should be taught the same systematic routine. Teaching it as a numbered sequence helps patients remember and perform it consistently:
1
Use soap and water for at least 20 seconds. Rinse thoroughly. Dry with a clean, lint-free towel—paper towels work well. Avoid moisturizing soaps that leave residue.
Title: Wash and Dry Hands
2
Always start with the same eye to avoid confusion between right and left lenses. Place the lens in your palm.
Title: Remove One Lens at a Time
3
Apply 3–5 drops of MPS or cleaning solution. Rub gently for 20–30 seconds with your index finger in a back-and-forth motion (not circular). Then rinse with fresh solution for 10 seconds.
Title: Rub and Rinse
4
Never "top off" old solution—pour it out, rinse the case with fresh solution, and fill with new solution. Topping off dilutes disinfectant and allows pathogen accumulation.
Title: Fill Clean Case with Fresh Solution
5
Follow the manufacturer's minimum soak time (typically 4–6 hours; 6–8 hours recommended). Do not shorten soak time.
Title: Soak for Recommended Time
6
Perform the same rub, rinse, and soak for the other lens. Place in the correctly labeled case compartment (R/L).
Title: Repeat for Second Lens
Contact Lens Solution Types
Understanding the different solution types helps you answer patient questions and avoid dangerous product mismatches:
| Solution Type | Function | Key Notes |
|---|
Lens Case Hygiene: The Forgotten Step
Studies show that a majority of contact lens cases are contaminated with bacteria, and many patients never properly clean their cases. The lens case is a major reservoir for Pseudomonas, Acanthamoeba, and other pathogens.
- text-green-600 — Do This — Rinse case with fresh lens solution after each use, Air dry face-down on a clean tissue, Replace case every 1–3 months, Replace case whenever switching solution brands
- text-red-600 — Never Do This — Rinse case with tap water, Top off old solution, Leave moisture in closed case, Use a cracked or scratched case
Replacement Schedules and Wearing Time
One of the most common patient compliance failures is extending lens wear beyond the prescribed replacement schedule. As a paraoptometric, you reinforce these limits at every visit.
- Daily Disposable — New pair every day; no cleaning required — Wearing multiple days is dangerous—deposits accumulate rapidly; no FDA-approved cleaning method exists for dailies
- 2-Week Replacement — Replace every 14 days of wear — Protein and lipid deposits increase infection risk after 2 weeks
- Monthly Replacement — Replace every 30 days of wear — Requires consistent daily cleaning; most common lens type associated with keratitis
- Extended / Continuous Wear — Up to 6–30 nights depending on FDA approval — Significantly higher infection risk; requires special lens material and careful patient selection
Water Exposure: The Acanthamoeba Risk
Acanthamoeba keratitis is rare but causes severe pain, photophobia, and potentially vision-threatening corneal scarring. The cysts are resistant to standard disinfectants and chlorinated pool water. Water exposure activities that require patient education include:
- Swimming — Remove lenses before swimming; if worn, use daily disposables and discard immediately after; wear goggles
- Hot Tubs / Jacuzzis — Never wear lenses; warm aerosolized water dramatically increases Acanthamoeba exposure
- Showering — Remove lenses before showering; if unavoidable, keep eyes closed and remove/replace immediately after
- Tap Water Contact — Never rinse lenses or cases with tap water; never store in homemade saline or distilled water
Patient Education Strategies
Telling patients the rules is not enough—explaining the "why" behind each step creates motivation to comply. Use these teaching approaches:
Use Analogies
Compare leaving solution in a case to leaving food in an unwashed bowl—bacteria multiply rapidly in moist protein-rich environments.
Teach One Step at a Time
During lens dispense visits, demonstrate each step while the patient watches. Have them perform the steps themselves before leaving.
Connect Symptoms to Habits
When a patient reports redness or discomfort, review their care routine step by step to identify the likely cause.
Written Instructions
Provide a take-home care card listing all steps and emergency contact information for after-hours concerns.
When in Doubt, Take Them Out
This simple phrase, repeatedly reinforced, prevents patients from continuing to wear problematic lenses while an infection develops.
What the CPO & CPOA Exams Test
Contact lens care questions on the CPO and CPOA exams typically focus on: