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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.
Under the supervision of the optometrist, paraoptometric staff perform lens dispense and training sessions. These appointments typically involve:
An inside-out lens is the most common beginner error. Several methods help patients reliably detect this:
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After washing and drying hands, remove the lens from its case, inspect it (ensure it's not inside out—check for a smooth edge vs. a flared edge), rinse with solution, and place it on the tip of the index finger. Pull down the lower lid with the middle finger and hold the upper lid open with the other hand. Look straight ahead or slightly up, place the lens on the cornea, and release the lids slowly. Blink gently. The lens should center immediately. If it folds or moves off-center, it may be inside out.
The classic "taco test" is most reliable: hold the lens by its edges and let it naturally curl. If it forms a taco shape with edges curling inward (like a bowl), it is right-side out. If the edges flare outward, it is inside out. Many lenses also have laser-engraved indicators (like "123" readable when right-side out vs. backwards when inverted) or are marked with a small dot. An inside-out lens may feel uncomfortable and move excessively on the eye.
Wash and dry hands. Confirm the lens is on the cornea (move it slightly with a finger if uncertain). Pull down the lower lid and look up, or look in the direction away from the pinch. Using the thumb and index finger in a pinching motion, gently grasp the lens from the bottom, squeeze slightly to break suction, and pull it off the eye. Never pinch or drag the lens from the cornea when the eye is looking straight ahead—always displace the gaze. Avoid long fingernails which can scratch the cornea.
A multi-session approach works best for anxious patients. In session 1, teach them to open the eye wide and overcome the blink reflex using their non-dominant hand. Practice just touching the white of the eye (sclera) without a lens to desensitize the blink. In session 2, attempt insertion with the lens. For extremely blink-sensitive patients, inserting while looking down at a mirror rather than straight ahead can reduce the blink reflex. Always validate the patient's experience—lens training can be frustrating—and schedule a follow-up insertion/removal training appointment if needed.
Patients should call the office if they cannot remove a lens after 5–10 attempts, if their eye is becoming red or painful, or if they suspect the lens is lost (gone under the lid). If the lens is displaced, it is likely up under the upper lid and has not "gone behind the eye"—the conjunctiva prevents this. Patients can try looking in the opposite direction and massaging the lid gently to dislodge it. Office staff can assist with a saline flush or sterile cotton-tip applicator to retrieve a displaced lens. A lens left in overnight when not approved for extended wear should be gently removed after applying rewetting drops to loosen it.
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