Tuesday, December 11, 2007

4.5 Sleeping with contacts

Contact lens over-wear is a problem of non-compliance. While some lenses are designed for overnight wear, most are not. Even the ones approved for 30-day continuous wear have some limitations as well.

In most cases, the patients report being too tired to take off the contacts the previous night. And this morning the eyes are in pain. Often the patients wait a few days hoping the eyes self-heal before seeking care. The root cause is still oxygen deprivation (or hypoxia) made worse during sleep when the eyes must close.

In mild cases, there is inflammation of the cornea, and in severe cases, additional microbial infection that may lead up to corneal ulceration. Treatment is case-dependent from palliative to anti-inflammatory and/or antibiotic therapy.

Now an opportunity to discuss contact lens compliance. It is often forgotten that contact lenses are a medical device. As such it is subject to the rules and regulation of the FDA. The doctor will always does his or her best to fit you with lenses that allow good vision and good comfort, within the prescribed wear-time. And it is the patient's responsibility to adhere to the wear schedule and keep the lenses clean.

Here is a quick list:

1. Replace contacts as required;
2. Replace or disinfect contact lens storage cases periodically and never allow solution to dry up in the cases;
3. Wash your hands with soap and water and rinse thoroughly before handling the lenses;
4. Do rub the lenses both sides, each side at least 10 sec even if you are using a "no-rub" multi-purpose solution and make sure the bottle is capped after each use;
5. True no-rub solution is H2O2-based which performs better than others in terms of disinfection;
6. Stop wearing lenses if the eyes look red and/or if you feel any discomfort;
7. Seek medical help as soon as possible, do not self-medicate.

And whatever you do, don't over-wear your contacts!!

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