Teaching patients to insert and remove their contact lenses is one of the most hands-on responsibilities of a paraoptometric professional. The dispensing and training appointment requires patience, clear communication, and proficiency with multiple lens types. The CPO and CPOA exams test your knowledge of proper technique, troubleshooting strategies, and patient safety during the training process.
The Paraoptometric's Role in Lens Training
Under the supervision of the optometrist, paraoptometric staff perform lens dispense and training sessions. These appointments typically involve:
Lens Verification
Confirm the dispensed lens parameters match the prescription (Rx) before the patient session begins.
Hygiene Education
Teach handwashing and drying before beginning any insertion or removal attempt.
Lens Inspection
Demonstrate how to inspect the lens for damage and verify correct orientation (right-side-out).
Insertion Demonstration
Demonstrate the technique on a training lens, then supervise the patient's attempts.
Removal Demonstration
Teach removal after successful insertion; ensure competency before the patient leaves.
Care System Review
Walk through the complete care routine with the actual products the patient will use at home.
Soft Contact Lens Insertion — Step by Step
Wash and Dry Hands
Soap + water for 20 seconds. Lint-free towel to dry completely. No moisturizing soaps.
N: 1
Retrieve and Inspect the Lens
Remove from solution. Hold toward light to check for tears, chips, or debris. Confirm it is right-side out (taco test or laser mark check).
N: 2
Rinse the Lens
Apply 2–3 drops of MPS and rinse briefly. This removes any residual solution and re-wets the lens.
N: 3
Place on Index Finger Tip
Dome-side up on the pad of the index finger. The lens should sit stably without slipping.
N: 4
Open the Eye
Dominant hand holds lens. Use middle finger of dominant hand to pull down the lower lid. Use the index finger of the non-dominant hand to hold the upper lid up against the orbital rim.
N: 5
Insert the Lens
Look straight ahead (or slightly upward at mirror). Bring lens to the cornea and gently press it on. Do not blink yet.
N: 6
Release and Center
Release the lids slowly. Blink gently once or twice. The lens should center automatically. If not, gently massage the lid or look in the direction of the displaced lens.
N: 7
Soft Contact Lens Removal — Step by Step
Wash and Dry Hands
Same hygiene standards as for insertion.
N: 1
Confirm Lens Position
Look in a mirror to confirm the lens is on the cornea, not displaced. If you cannot see the lens, it may be under the upper lid—look down and tug the upper lid gently upward.
N: 2
Apply Rewetting Drop if Dry
If the eye feels dry or the lens feels stuck, instill one rewetting drop and wait 30 seconds before attempting removal.
N: 3
Pull Down Lower Lid
Use the middle finger of the dominant hand to pull down the lower lid.
N: 4
Look Up or Away
Looking upward or in the opposite direction from where you will pinch helps expose the inferior lens edge.
N: 5
Pinch and Remove
Using thumb and index finger, gently pinch the lower portion of the lens. A slight squeeze breaks the lens-cornea suction. Slide the lens off the eye in a downward motion.
N: 6
Store or Discard
Daily disposables: discard. Reusable: clean immediately using rub-and-rinse method, then soak in fresh solution.
N: 7
Checking for Correct Lens Orientation
An inside-out lens is the most common beginner error. Several methods help patients reliably detect this:
Taco Test
Gently squeeze the lens edges together. Correct orientation: edges curl inward (bowl shape). Inside-out: edges flare outward.
Profile Inspection
Hold the lens at eye level and look at its edge profile from the side. Correct: hemispherical dome. Inside-out: flared rim visible.
Laser Engravings
Many lenses have "123" or other marks. When right-side out, the text reads normally. Inside-out, it reads backwards or inverted.
Troubleshooting Common Patient Difficulties
- Cannot stop blinking — Practice with lubricating drops without a lens first to desensitize. Try inserting while looking down at a tabletop mirror rather than into a wall mirror—different gaze angle helps some patients.
- Lens folds on the eye — The lens may be inside out, or the patient may be blinking before the lens fully adheres. Teach them to hold the lids open for 2 full seconds after placing the lens.
- Lens slides off the cornea — May be inside out (slippery edge) or the patient's cornea is very dry. Have them blink once or center with light fingertip pressure on the closed lid over the lens position.
- Cannot grasp lens for removal — Make sure hands are fully dry (not just rinsed). Teach them to look upward and pinch from the lower edge—this avoids trying to grab from the center where suction is strongest.
- Fingernail interferes — Short, well-trimmed nails are essential for safe insertion and removal. If nails are long, use the side of the fingertip or a lens applicator tool.
- Excessive anxiety / distress — Normalize the experience—many new wearers take 20–30 minutes for their first session. Schedule a follow-up training visit rather than extending a single session past 45–60 minutes.