ConditionEyes & vision
Contact Lens Complications
Contact lens complications are eye problems caused or worsened by wearing contact lenses. Most are minor, such as dryness, irritation or allergy to deposits on the lens. The most serious is microbial keratitis, a corneal infection that can scar the eye and cause permanent vision loss. Sleeping in lenses and exposing them to water are the biggest risks. A painful red eye with blurred vision or light sensitivity in a lens wearer needs same-day eye care.
Also called: Contact lens-related eye problems, contact lens-induced eye conditions, contact lens red eye, contact lens infection
At a glance
- Common problems
- Dry eye, irritation, allergic or giant papillary conjunctivitis, corneal abrasion.
- Serious problems
- Bacterial, fungal or Acanthamoeba keratitis (corneal infection).
- Biggest risks
- Sleeping in lenses, tap water or swimming, poor case hygiene, overwearing lenses.
- Warning signs
- Pain, redness, light sensitivity, blurred vision, discharge.
- First step
- Remove lenses immediately and see an eye doctor if symptoms do not clear quickly.
When to get help
Call 911 or go to the ER
- A painful red eye with a white spot on the cornea, rapidly worsening vision, or severe pain in a lens wearer
- A chemical splash or lens solution containing hydrogen peroxide put directly in the eye with severe pain. Rinse with water for 15 to 20 minutes and seek care
See a doctor within a day or two
- Eye pain, redness, light sensitivity, blurred vision or discharge that does not clear within a few hours of removing lenses. See an eye doctor the same day
- A lens that seems stuck or lost in the eye with pain
- Severe pain out of proportion to redness, especially after swimming or using tap water with lenses
Book a routine appointment
- Itchy eyes, mucus and lenses moving around or blurring through the day
- Dryness, gritty feeling or reduced wearing time
- Persistent redness of the white of the eye with lens wear
Usually safe to manage at home
- Mild dryness at the end of the day that improves with lubricating drops and shorter wearing time
Why contact lenses cause problems
The cornea gets most of its oxygen directly from the air. A lens reduces oxygen, especially during sleep, when the eyelid is closed. Lenses also rub the corneal surface, trap debris and bacteria against it, and alter the tear film. Combined with contaminated cases or solutions, these factors allow infection and inflammation.
About 45 million people in the US wear contact lenses, and most wearers admit to at least one risky habit.
Common contact lens complications
| Problem | Symptoms | Cause |
|---|---|---|
| Contact lens-related dry eye | Gritty, dry eyes, blur, reduced comfort late in the day | Lens absorbs tear film, screen use |
| Giant papillary conjunctivitis | Itching, mucus, lens moving up, bumps under the upper lid | Allergic reaction to lens deposits |
| Corneal abrasion | Sharp pain, watering, light sensitivity | Torn lens, debris, inserting or removing lenses |
| Contact lens acute red eye | Sudden painful red eye on waking | Overnight wear, toxins from bacteria |
| Sterile corneal infiltrates | Mild pain, redness, small white spots | Inflammation, often from solutions or overwear |
| Corneal neovascularization | Usually none at first, blood vessels growing into the cornea | Chronic low oxygen |
| Solution toxicity or allergy | Burning, redness after insertion | Preservatives or peroxide not neutralized |
Serious infections
Bacterial keratitis
The most common serious complication, often caused by Pseudomonas. Pain, redness, light sensitivity, discharge and a white spot on the cornea develop over hours. See bacterial keratitis.
Acanthamoeba keratitis
A rare but devastating infection from an amoeba found in tap water, swimming pools, hot tubs and soil. Pain is often severe and out of proportion to how the eye looks, and it is frequently mistaken for herpes at first. Treatment takes months. See Acanthamoeba keratitis.
Fungal keratitis
Associated with plant injuries, warm climates, and outbreaks linked to certain contact lens solutions. See fungal keratitis.
Risk factors
- sleeping or napping in lenses, which raises the risk of keratitis several times
- showering, swimming or using hot tubs in lenses
- rinsing lenses or cases with tap water, or storing lenses in water
- "topping off" old solution instead of replacing it
- wearing lenses longer than prescribed, or not replacing cases at least every 3 months
- buying lenses without a prescription, including decorative or costume lenses
- smoking
Diagnosis
An eye care professional examines the eye with a slit lamp and fluorescein dye to check for abrasions, infiltrates and ulcers. They inspect the lens fit and surface. If an infection is suspected, they may take a corneal scraping for culture, and culture the lens and case. Bring your lenses and case to the appointment.
Treatment
- Stop wearing lenses until the eye has fully healed and your eye doctor approves.
- Lubricating drops for dryness.
- Antibiotic drops for abrasions in lens wearers (with coverage for Pseudomonas) and intensive drops for keratitis.
- Antiallergy drops and switching to daily disposable lenses for giant papillary conjunctivitis.
- Refitting with higher-oxygen lenses, a different material or care system, or switching to glasses part-time.
- Avoid patching an abrasion in a contact lens wearer, because it can encourage infection.
Safe contact lens habits
- Wash and dry your hands before touching lenses.
- Never sleep in lenses unless your eye doctor has specifically approved it.
- Keep water away from lenses: no swimming, showering or tap water rinses.
- Use fresh solution every time, and rub and rinse lenses as directed.
- Empty, rinse with solution, and air-dry the case face down. Replace it at least every 3 months.
- Replace lenses on schedule. Daily disposables are the lowest-maintenance option.
- Carry glasses as a backup.
- Remove lenses at the first sign of discomfort, and see your eye doctor if it does not settle.
- Have regular eye exams and only buy lenses with a valid prescription.
Frequently asked questions
What are the signs of a contact lens infection?
Signs include eye pain, redness, light sensitivity, blurred vision, watering or discharge, and sometimes a white spot on the cornea. Remove your lenses and see an eye doctor the same day, because infections can damage the cornea within a day or two.
What happens if you sleep in contact lenses?
Sleeping in lenses reduces oxygen to the cornea and greatly increases the risk of serious infection, even with lenses labeled for extended wear. An occasional nap may cause only redness, but repeated overnight wear is the main risk factor for keratitis.
Why are my eyes red after wearing contacts?
Common causes are dryness, overwearing lenses, a poorly fitting or damaged lens, allergy to deposits or solution, or a scratch. If redness comes with pain, light sensitivity or blurred vision, it may be an infection, so remove the lenses and seek care.
Can you swim with contact lenses?
It is safest not to. Pool, lake, sea and tap water can carry Acanthamoeba and bacteria that cling to lenses. If you must, wear tight-fitting goggles, and throw away daily disposable lenses after swimming. Prescription goggles are a good alternative.
Can contact lenses cause permanent damage?
Most problems heal completely when caught early. Serious corneal infections can cause scarring and permanent vision loss, occasionally requiring a corneal transplant. Following safe lens habits and seeking prompt care prevent most serious outcomes.
Sources
This guide was written from current patient and clinical guidance, including:
- CDC: Contact Lens Health, Healthy Habits and Complications
- American Academy of Ophthalmology: Contact Lens Safety
- US Food and Drug Administration: Focusing on Contact Lens Safety
- American Optometric Association: Contact Lens Safety
- MedlinePlus: Contact lenses