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Complications of contact lenses

Karen S DeLoss, OD
H Kaz Soong, MD
Christopher T Hood, MD
Section Editor
Jonathan Trobe, MD
Deputy Editor
Howard Libman, MD, FACP


Millions of people worldwide wear contact lenses. Noninfectious and infectious complications of contact lenses are common and vary in severity from clinically inconsequential to potentially vision-threatening. In a survey of contact lens wearers in the United States, nearly one-third had experienced a contact lens-related condition that required a doctor's visit [1].

Primary care and emergency department clinicians are often the first to evaluate patients with contact lens–related problems. Although many of these conditions necessitate referral to an eye care specialist, familiarity with these complications by the frontline clinician will allow prompt diagnosis, treatment, and appropriate triage.

The presentation and management of complications associated with contact lenses will be reviewed here. An overview of contact lenses and specific microbial infections related to contact lens wear are discussed separately. (See "Overview of contact lenses" and "Clinical manifestations and diagnosis of Fusarium infection", section on 'Keratitis' and "Free-living amebas and Prototheca", section on 'Keratitis'.)


The maintenance of a smooth and transparent anterior refractive surface is critical to good vision. A complex interplay between the corneal and conjunctival epithelium, the tear film, and the overlying eyelids provides protection against infection and scarring. Noninfectious complications are minimized with a well-fit contact lens that both rests on the pre-corneal tear film and moves only enough to allow good fluid and gas exchange, thereby functioning as a de facto extension of the ocular surface.

Dryness — Contact lens-related dryness is commonly encountered and is the most frequent reason for contact lens discontinuation. Dryness can be caused by poor tear film, oxygen deprivation, lens deposits, and contact lens solution incompatibility [2-6]. Treatment includes artificial tears with and without contact lenses, topical cyclosporine 0.05%, and management of blepharitis and meibomian gland dysfunction when applicable. Patients may benefit from using lubricant eye drops before and after contact lens wear [7], refitting with a higher oxygen permeable lens material, or switching contact lens care solutions. (See "Dry eyes" and "Blepharitis".)

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Literature review current through: Nov 2017. | This topic last updated: Sep 25, 2017.
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  1. Cope JR, Collier SA, Rao MM, et al. Contact Lens Wearer Demographics and Risk Behaviors for Contact Lens-Related Eye Infections--United States, 2014. MMWR Morb Mortal Wkly Rep 2015; 64:865.
  2. Sindt CW, Longmuir RA. Contact lens strategies for the patient with dry eye. Ocul Surf 2007; 5:294.
  3. The definition and classification of dry eye disease: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf 2007; 5:75.
  4. Paulsen AJ, Cruickshanks KJ, Fischer ME, et al. Dry eye in the beaver dam offspring study: prevalence, risk factors, and health-related quality of life. Am J Ophthalmol 2014; 157:799.
  5. Dumbleton K, Woods CA, Jones LW, Fonn D. The impact of contemporary contact lenses on contact lens discontinuation. Eye Contact Lens 2013; 39:93.
  6. Nichols JJ, Willcox MD, Bron AJ, et al. The TFOS International Workshop on Contact Lens Discomfort: executive summary. Invest Ophthalmol Vis Sci 2013; 54:TFOS7.
  7. McDonald M, Schachet JL, Lievens CW, Kern JR. Systane® ultra lubricant eye drops for treatment of contact lens-related dryness. Eye Contact Lens 2014; 40:106.
  8. Bates AK, Morris RJ, Stapleton F, et al. 'Sterile' corneal infiltrates in contact lens wearers. Eye (Lond) 1989; 3 ( Pt 6):803.
  9. Gordon A, Kracher GP. Corneal infiltrates and extended-wear contact lenses. J Am Optom Assoc 1985; 56:198.
  10. Szczotka-Flynn L, Jiang Y, Raghupathy S, et al. Corneal inflammatory events with daily silicone hydrogel lens wear. Optom Vis Sci 2014; 91:3.
  11. Szczotka-Flynn L, Chalmers R. Incidence and epidemiologic associations of corneal infiltrates with silicone hydrogel contact lenses. Eye Contact Lens 2013; 39:49.
  12. Chalmers RL, Wagner H, Mitchell GL, et al. Age and other risk factors for corneal infiltrative and inflammatory events in young soft contact lens wearers from the Contact Lens Assessment in Youth (CLAY) study. Invest Ophthalmol Vis Sci 2011; 52:6690.
  13. Zimmerman AB, Emch AJ, Geldis J, et al. Contact Lens Corneal Inflammatory Events in a University Population. Optom Vis Sci 2016; 93:42.
  14. Zantos SG. Cystic formation in the corneal epithelium during extended wear of contact lenses. Int Contact Lens Clin 1983; 10:128.
  15. Clemons CS, Cohen EJ, Arentsen JJ, et al. Pseudomonas ulcers following patching of corneal abrasions associated with contact lens wear. CLAO J 1987; 13:161.
  16. Catania LJ. Management of corneal abrasions in an extended-wear patient population. Optom Clin 1991; 1:123.
  17. Turner A, Rabiu M. Patching for corneal abrasion. Cochrane Database Syst Rev 2006; :CD004764.
  18. McMonnies CW. Contact-lens induced corneal vascularization. Int Contact Lens Clin 1983; 10:12.
  19. Sweeney DF. Have silicone hydrogel lenses eliminated hypoxia? Eye Contact Lens 2013; 39:53.
  20. Hsu M, Tu E, Bouchard C. Confocal microscopy of contact lens keratitis presenting as central toxic keratopathy. Eye Contact Lens 2011; 37:377.
  21. Theodore FH. Superior limbic keratoconjunctivitis. Arch Ophthalmol 1983; 101:1627.
  22. Fuerst DJ, Sugar J, Worobec S. Superior limbic keratoconjunctivitis associated with cosmetic soft contact lens wear. Arch Ophthalmol 1983; 101:1214.
  23. Miller RA, Brightbill FS, Slama SL. Superior limbic keratoconjunctivitis in soft contact lens wearers. Cornea 1982; 1:293.
  24. Burns JA, Cahill KV. Long-term dislocation of a hard contact lens. Ophthalmic Surg 1986; 17:493.
  25. Weinstein GS, Myers BB. Eyelid retraction as a complication of an embedded hard contact lens. Am J Ophthalmol 1993; 116:102.
  26. Nicolitz E, Flanagan JC. Orbital mass as a complication of contact lens wear. Arch Ophthalmol 1978; 96:2238.
  27. Sebag J, Albert DM. Pseudochalazion of the upper lid due to hard contact lens embedding -- case reports and literature review. Ophthalmic Surg 1982; 13:634.
  28. Mimura T, Yamagami S, Mori M, et al. Contact lens-induced subconjunctival hemorrhage. Am J Ophthalmol 2010; 150:656.
  29. Bourne WM, Hodge DO, McLaren JW. Estimation of corneal endothelial pump function in long-term contact lens wearers. Invest Ophthalmol Vis Sci 1999; 40:603.
  30. Bourne WM, Holtan SB, Hodge DO. Morphologic changes in corneal endothelial cells during 3 years of fluorocarbon contact lens wear. Cornea 1999; 18:29.
  31. MacRae SM, Matsuda M, Phillips DS. The long-term effects of polymethylmethacrylate contact lens wear on the corneal endothelium. Ophthalmology 1994; 101:365.
  32. Huang AJ, Tseng SC. Corneal epithelial wound healing in the absence of limbal epithelium. Invest Ophthalmol Vis Sci 1991; 32:96.
  33. Shapiro MS, Friend J, Thoft RA. Corneal re-epithelialization from the conjunctiva. Invest Ophthalmol Vis Sci 1981; 21:135.
  34. Rossen J, Amram A, Milani B, et al. Contact Lens-induced Limbal Stem Cell Deficiency. Ocul Surf 2016; 14:419.
  35. Chan CC, Holland EJ. Severe limbal stem cell deficiency from contact lens wear: patient clinical features. Am J Ophthalmol 2013; 155:544.
  36. Martin R. Corneal conjunctivalisation in long-standing contact lens wearers. Clin Exp Optom 2007; 90:26.
  37. Bhatia RP, Srivastava R, Ghosh A. Limbal stem cell study in contact lens wearers. Ann Ophthalmol (Skokie) 2009; 41:87.
  38. Jeng BH, Halfpenny CP, Meisler DM, Stock EL. Management of focal limbal stem cell deficiency associated with soft contact lens wear. Cornea 2011; 30:18.
  39. Kim BY, Riaz KM, Bakhtiari P, et al. Medically reversible limbal stem cell disease: clinical features and management strategies. Ophthalmology 2014; 121:2053.
  40. Tseng SC, Prabhasawat P, Barton K, et al. Amniotic membrane transplantation with or without limbal allografts for corneal surface reconstruction in patients with limbal stem cell deficiency. Arch Ophthalmol 1998; 116:431.
  41. Liesegang TJ. Contact lens-related microbial keratitis: Part I: Epidemiology. Cornea 1997; 16:125.
  42. Thomas PA, Geraldine P. Infectious keratitis. Curr Opin Infect Dis 2007; 20:129.
  43. Schein OD, Buehler PO, Stamler JF, et al. The impact of overnight wear on the risk of contact lens-associated ulcerative keratitis. Arch Ophthalmol 1994; 112:186.
  44. Lee SY, Kim YH, Johnson D, et al. Contact lens complications in an urgent-care population: the University of California, Los Angeles, contact lens study. Eye Contact Lens 2012; 38:49.
  45. Keay L, Stapleton F, Schein O. Epidemiology of contact lens-related inflammation and microbial keratitis: a 20-year perspective. Eye Contact Lens 2007; 33:346.
  46. Young G, Young AG, Lakkis C. Review of complications associated with contact lenses from unregulated sources of supply. Eye Contact Lens 2014; 40:58.
  47. Singh S, Satani D, Patel A, Vhankade R. Colored cosmetic contact lenses: an unsafe trend in the younger generation. Cornea 2012; 31:777.
  48. Keay L, Edwards K, Naduvilath T, et al. Microbial keratitis predisposing factors and morbidity. Ophthalmology 2006; 113:109.
  49. Wagner H, Richdale K, Mitchell GL, et al. Age, behavior, environment, and health factors in the soft contact lens risk survey. Optom Vis Sci 2014; 91:252.
  50. Cope JR, Collier SA, Nethercut H, et al. Risk Behaviors for Contact Lens-Related Eye Infections Among Adults and Adolescents - United States, 2016. MMWR Morb Mortal Wkly Rep 2017; 66:841.
  51. Huang AJ, Wichiensin P, Yang M. Bacterial keratitis. In: Cornea, 2nd ed, Krachmer JH, McMannis MJ, Holland EJ (Eds), Elseverier Mosby, Philadelphia 2005. Vol 1.
  52. Mondino BJ, Weissman BA, Farb MD, Pettit TH. Corneal ulcers associated with daily-wear and extended-wear contact lenses. Am J Ophthalmol 1986; 102:58.
  53. McDonnell PJ, Nobe J, Gauderman WJ, et al. Community care of corneal ulcers. Am J Ophthalmol 1992; 114:531.
  54. Hoddenbach JG, Boekhoorn SS, Wubbels R, et al. Clinical presentation and morbidity of contact lens-associated microbial keratitis: a retrospective study. Graefes Arch Clin Exp Ophthalmol 2014; 252:299.
  55. Donzis PB, Mondino BJ, Weissman BA, Bruckner DA. Microbial analysis of contact lens care systems contaminated with Acanthamoeba. Am J Ophthalmol 1989; 108:53.
  56. Donzis PB, Mondino BJ, Weissman BA, Bruckner DA. Microbial contamination of contact lens care systems. Am J Ophthalmol 1987; 104:325.
  57. Konda N, Motukupally SR, Garg P, et al. Microbial analyses of contact lens-associated microbial keratitis. Optom Vis Sci 2014; 91:47.
  58. Suwan-Apichon O, Reyes JM, Herretes S, et al. Topical corticosteroids as adjunctive therapy for bacterial keratitis. Cochrane Database Syst Rev 2007; :CD005430.
  59. Robin JS, Ellis PP. Ophthalmic ointments. Surv Ophthalmol 1978; 22:335.
  60. Ly CN, Pham JN, Badenoch PR, et al. Bacteria commonly isolated from keratitis specimens retain antibiotic susceptibility to fluoroquinolones and gentamicin plus cephalothin. Clin Exp Ophthalmol 2006; 34:44.
  61. Parmar P, Salman A, Kalavathy CM, et al. Comparison of topical gatifloxacin 0.3% and ciprofloxacin 0.3% for the treatment of bacterial keratitis. Am J Ophthalmol 2006; 141:282.
  62. Scoper SV. Review of third-and fourth-generation fluoroquinolones in ophthalmology: in-vitro and in-vivo efficacy. Adv Ther 2008; 25:979.