Intended for healthcare professionals

Practice Practice Pointer

Eye problems in contact lens wearers

BMJ 2019; 367 doi: (Published 27 November 2019) Cite this as: BMJ 2019;367:l6337
  1. Syed M Shahid, specialist registrar in ophthalmology1,
  2. Syed N Ahmed, Foundation Year 22,
  3. Yusra Khan, general practitioner3
  1. 1Moorfields Eye Hospital, London, UK
  2. 2Eastbourne District General Hospital, Eastbourne, UK
  3. 3Stoke Gifford Medical Centre, Bristol, UK
  1. Corresponding author SM Shahid ss4562{at}

What you need to know

  • Contact lens associated keratitis can cause blindness and requires same day assessment and management at an eye emergency department

  • Overuse of contact lenses is a known risk factor for keratitis

  • Refer contact lens users with a painful red eye for same day eye emergency assessment to avoid missing a sight threatening complication such as microbial keratitis

More than 140 million people worldwide wear contact lenses.1 Contact lens wearers are more prone to ocular surface problems, particularly those who use extended wear contact lenses.23 Patients may present to the general practitioner, pharmacist, or optometrist in approximately 42% of cases.4 Clinicians in acute care need to be able to identify sight threatening conditions such as microbial keratitis, and advise on more common problems such as a retained contact lens or contact lens discomfort. This article outlines the common eye conditions associated with contact lens wear and an approach that non-specialists can use to identify and manage them.

Approach in primary care

Accurate diagnosis and treatment of contact lens related problems in the non-specialist setting is challenging. Firstly, in the case of someone presenting with a red eye, the wide differential diagnosis of the red eye has to be considered in addition to the specific contact lens related complications described in this article.5 Secondly, a slit lamp is required to confirm the diagnosis in most cases. As such, in primary care an assessment may be limited to identifying a likely cause, and making a judgment about the risk of a serious or sight threatening complications and need for urgent eye specialist assessment. Forming this judgment is summarised in figure 1. We recommend that if a clinician is uncertain about the diagnosis, they should seek further advice from an eye specialist. Advise patients to abstain from using contact lenses while awaiting specialist …

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