Contact Lens Care and Solutions
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Title: Contact Lens Care and Solutions
Authors: David Meyer, OD, FAAO, Meagan Miles, OD
Photographer: Meagan Miles, OD
Date: 12/16/2020
Keywords/Main Subjects: contact lenses, contact lens care, contact lens solutions
Contact Lens Care and Solutions
The key to successful contact lens wear is good contact lens care. With all the options for contact lens solutions, picking the right solution can be overwhelming to patients.
Figure 1. Picture of contact lens solutions and artificial tears
Proper Soft Contact Lens Care
Always wash your hands with a soap that does not contain lotion or moisturizer before handling a contact lens. It is best to consistently work with one eye first to avoid mixing up the right and left lenses.
When using multipurpose solution:
When using a multipurpose solution, place the contact lens in the palm of your hand and rub with solution for approximately 20 seconds, although actual time varies by brand. There are currently no “no rub” multipurpose solutions on the market due to their increased risk of causing corneal infections. Next, rinse the lens, place it in the case, and immerse completely with solution. Leave the contact lenses in the case for approximately four to six hours, although actual time varies by solutions (see below). Never “top off” the solution in the case. Topping off does not allow a high enough concentration of disinfectant for the solution to be effective. Never put tap water on a soft contact lens. Soft lenses act like sponges and hold on to irritants and microbes that are in the water. Also, avoid getting pool, hot tub, river, lake, or ocean water on your contact lenses.
When using a hydrogen peroxide solution:
To use a hydrogen peroxide solution, again start by washing your hands. Place each contact lens in the appropriate chamber on the case. Rinse each lens with the solution for at least five seconds. Fill the clear case to the fill line and place the chamber in the case. It is normal for the case to bubble and gas to escape from the top of the case. Leave the contact lenses in the case for at least six hours. You must use a case that is made for hydrogen peroxide solutions. If you do not use the appropriate case or wait for at least six hours, then there will be burning and damage to the front of your eyes when you put the contact lenses in you eyes. Never put hydrogen peroxide solutions directly into your eyes. Since hydrogen peroxide solutions do not have additional preservatives, they do not kill pathogens after the first six hours and are not appropriate for long term storage. It is only safe to keep the lenses in the solutions for up to seven days.
Contact lens cases should be allowed to air dry open side down on a clean surface when not in use. Cases should be replaced every three months. Generally, solution comes with a new contact lens case. Not replacing your case can cause the formation of a biofilm that most solutions cannot disinfect. Even if the case appears clean to the naked eye, there are still likely microbes you cannot see.
Types of Soft Contact Lens Solutions
Multipurpose solutions (MPS) are used to clean and disinfect contact lenses. All currently available MPS must be rubbed on the contact lens before storage for them to be fully effective. MPS are safe to put in the eye. A summary of different types of MPS for soft contact lenses can be found on Table 1.
Hydrogen peroxide solutions use hydrogen peroxide to clean and disinfect contact lenses. They must be used with a case made for hydrogen peroxide, which neutralizes the solution into plain saline after six hours. If you do not wait the full six hours or put the solution directly into your eye, hydrogen peroxide will burn and damage the eye. Hydrogen peroxide solutions are preservative fee, which means they are a good option for patients with sensitivities to preservatives or have dry eye syndrome. However, since there is no preservative once the hydrogen peroxide is neutralized, it cannot be used to store lenses for more than seven days.
Plain saline should not be used for cleaning or storing contact lenses, because it does not contain any disinfectant and can lead to corneal infection.
Table 1. Soft Contact Lens Solutions (Click to enlarge table)
Proper Gas-Permeable (GP) Contact Lens Care
Always wash your hands with a soap that does not contain lotion or moisturizer before handling a contact lens. It is best to consistently work with one eye first to avoid mixing up the right and left lenses. After removing the contact lens, place it in the palm of your hand, place several drops of cleaner and gently rub each side for 10-15 seconds. Rinse with multipurpose solutions or saline. Cleaning agents with a red or maroon top will burn if not rinsed completely. There is some disagreement on whether it is safe to rinse GP lenses with tap water. It is still currently approved by the FDA, but there is some concern of increased infection risk. Most contact lens manufactures and solution instructions state to never rinse even GP contact lenses with water. If rinsing with tap water, you must use another solution that is safe for your eyes afterward. You never want tap water to be the last thing on the contact lens before it is placed in your eye. After rinsing, place the lens in the case and immerse completely with a conditioning or soaking solution and allow it to sit for at least four to six hours.
When inserting a corneal GP or hybrid lens it is optional to put a few drops of an eye-safe solution in the lens before inserting. This can make insertion easier and the lens more comfortable. For scleral contact lenses it is required to fill the bowl of the lens completely with preservative-free filling solution. There is very little tear exchange with a scleral lens, so the solution in the bowl of the lens sits on the front surface the eye nearly all day. If a preservative is used, it can irritate and damage the eye. In severe dry eyes, a drop or two of preservative-free artificial tears may also be placed in the bowl of the lens with the preservative-free saline before insertion to increase comfort.
Types of GP Contact Lens Solutions
Cleaning-only solutions have a red cap and are used to rub GP contact lenses clean. They must be completely rinsed off and are not safe to go directly into the eyes. If using a cleaning-only solution, a separate disinfectant solution must be used to soak the contact lens during storage. Cleaning-only solutions may also strip HydraPEG coating from GP contact lenses and should not be used on lenses with this coating.
Enzymatic cleaners can be added to the normal soaking regiment once every few months, monthly, biweekly, or weekly, depending on the amount of protein deposits on the lenses. Enzymatic cleaners only remove proteins, not lipids. Enzymatic cleaners are added to the normal overnight disinfection solutions. Contact lenses must be rinsed after using an enzymatic cleaner and the case must be cleaned with soap and water.
Lab strength cleaners are not commercially available. They are heavy duty cleaners only available for use in office. They can cause damage to the contact lens if used too frequently or for an extended period.
Table 2. Gas-permeable contact lens cleaners (Click to enlarge table)
Cleaning and disinfection multipurpose solutions can be used to rub the contact lenses clean and soak them during storage. They can also be used in combination with a cleaning-only solution or a soaking and conditioning solution.
Soaking and conditioning solutions are used to store the contact lens and help to make the contact lenses more comfortable. They must be used in combination with a cleaning solution before soaking.
Hydrogen peroxide solutions can be used to clean and soak the lenses. They must be used with a case made for hydrogen peroxide, which neutralizes the solution to plain saline after six hours. The standard hydrogen peroxide case is only recommended for GP lenses up to about 16.6mm diameter. Larger lenses have an increased chance of breaking, if using the standard case. There is a custom case available made for larger lenses called the PROSE Disinfection Case. If using a custom case, the platinum catalyst disc must be removed from the standard case and placed into the custom case to allow the peroxide to be neutralized. The custom case also uses about three times the solution of the standard case. With both cases, you most allow the solution to soak for at least six hours. If you do not wait the full six hours or put the solution directly into your eye, hydrogen peroxide will burn and damage the eye. These solutions are preservative fee, which means they are a good option for patients with sensitivities to preservatives or dry eye syndrome. However, since there is no preservative once the hydrogen peroxide is neutralized, it cannot be used to store lenses for more than seven days.
Table 3. Gas-permeable contact lens disinfectants (Click to enlarge table)
Filling agents are preservative free solutions used to fill scleral contact lenses. They do not contain disinfectants and cannot be used for cleaning or storing the lenses. Most are available in single use vials. This is preferred since these agents do not contain preservative; it minimizes the amount of time a solution can become contaminated. Single use vials should be discarded 24 hours after opening. Purilens is a preservative-free saline available in a bottle, meaning it is at higher risk on becoming contaminated. Purilens should be discarded fifteen days after opening.
Table 4. Gas-permeable contact lens filling agents (Click to enlarge table)
A note on Hydra-PEG: Tangible Hydra-PEG is a coating added to GP contact lenses at the time of production. It is used to promote wettability, decrease fogging, and decrease deposits. It launched in 2017. The only US solutions approved for lenses with Hydra-PEG are Tangible Clean, Boston Simplus, ClearCare, ClearCare Plus, and Unique pH. Tap water and non-approved solutions can strip the coating from the lenses. Lenses with Hydra-PEG must be stored in solution, unlike other GP lenses, they cannot be stored dry.
Faculty Approval by: Griffin Jardine, MD
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