What each contact lens care system does and how patients should use it, then practice cases: the patient tells you what is wrong, you decide what to change.
Care systems
Cleaning
Loosens and removes deposits, debris and some germs from the lens surface, mostly by rubbing. It does not make the lens safe on its own.
Disinfecting
Kills the germs that can cause serious eye infections. This is the step a care system cannot skip.
Sterilizing
Kills every organism, spores included. Lens care systems disinfect; they do not sterilize.
Multipurpose solution
Soft lenses
Cleans
Disinfects
Stores
One bottle that cleans, rinses, disinfects and stores soft lenses. It is the care system most soft lens wearers use.
How to use it
Rub each lens with fresh solution, then rinse it, every time it comes out.
Store the lenses in fresh solution in a clean case.
Each day, rub and rinse the empty case with solution, empty it, wipe it dry with a clean tissue and leave it upside down with the caps off.
Never
Top off: never add fresh solution to what is left in the case.
Rinse the lenses or the case with water.
Hydrogen peroxide system
Soft lenses (some rigid lenses too)
Cleans
Disinfects
Stores
Disinfects with hydrogen peroxide, which the special case slowly turns into harmless saline. Often chosen for patients who react to an ingredient in multipurpose solution.
How to use it
Use only the special case that comes with the solution; it does the neutralizing.
Put the lenses in the case with fresh solution and wait the full time on the label, at least 4 to 6 hours, before wearing them.
Most systems also need a daily cleaner to remove deposits.
Never
Use any other case: the peroxide will not neutralize, and the lenses will burn and sting when inserted.
Rinse lenses with the peroxide solution and put them straight in the eye.
Mix fresh solution with old solution.
Saline
Soft and rigid lenses
Does not cleans
Does not disinfects
Does not stores
Sterile salt water for rinsing only. Some peroxide systems suggest a saline rinse before insertion.
How to use it
Rinse lenses after they have been cleaned and disinfected by another system.
Never
Use saline in place of a disinfecting solution.
Daily cleaner
Soft and rigid lenses (use the product made for the lens type)
Cleans
Does not disinfects
Does not stores
A cleaner that loosens deposits and debris. It cleans; it does not disinfect.
How to use it
Put a few drops in the palm and rub both sides of the lens for as long as the label says.
Rinse it off and disinfect with another product, such as multipurpose solution.
Never
Store lenses in daily cleaner or treat it as a disinfectant.
Enzymatic protein remover
Soft and rigid lenses, when the eye care provider recommends it
Cleans
Does not disinfects
Does not stores
A liquid or tablet that breaks down the protein tears leave on lenses over time. Used daily or weekly depending on the product and how quickly deposits build.
How to use it
Use it on the schedule the eye care provider sets, then rinse and disinfect.
Never
Start it without asking the eye care provider first.
Rigid gas permeable care
Rigid (GP) lenses
Cleans
Disinfects
Stores
Rigid lenses usually need their own products for cleaning, disinfecting and conditioning (wetting). The eye care provider picks the system.
How to use it
Clean, then disinfect and store in the conditioning solution the provider recommends.
A wetting or conditioning solution helps tears spread over the lens when it goes in.
Never
Use rigid lens products on soft lenses.
Troubleshooting cases
16 cases
Soft lens fit
Comfortable at first, red and achy by afternoon
“They feel fine when I put them in, but by mid-afternoon my eyes are red and they ache.”
What you find
Almost no lens movement on blink; the push-up test is sluggish.
A ring-shaped imprint on the conjunctiva at the lens edge after removal.
Vision is briefly clearer right after each blink.
Soft lens fit
Lens slides and vision blurs after each blink
“My right lens keeps sliding around, and everything blurs for a moment every time I blink.”
What you find
About 1.5 mm of movement on blink and the lens drops after the blink.
The lens edge lifts (fluting) at the bottom.
The patient is aware of the lens edge.
Rigid lens fit
Rigid lens rides high and feels edgy
“I can feel the edge of the lens, and it moves around so much it sometimes pops out.”
What you find
Current lens: BC 42.75 D, power −3.00 D.
Fluorescein: dark central touch with a wide bright band of pooling at the edge.
Lens decenters and moves excessively.
Rigid lens fit
Rigid lens barely moves and vision fluctuates
“My vision goes in and out, and my eyes feel tired and dry by the end of the day.”
What you find
Current lens: BC 44.50 D, power −1.75 D.
Fluorescein: bright central pooling with a trapped bubble and a dark ring of touch near the edge.
Very little movement on blink.
Vision
Toric lens is blurry: it has rotated
“Things are a bit blurry and shadowy in my left eye since I started these new lenses.”
What you find
Lens ordered: −2.25 −1.25 × 180.
The rotation mark sits 10° to your left (clockwise, as you face the patient) and stays there blink after blink.
The lens is centered and moves normally.
Vision
Well-fitted spherical rigid lens, still blurry
“The lenses are comfortable, but my vision is still not as sharp as my glasses.”
What you find
Spectacle Rx −3.00 −1.50 × 180.
Keratometry 43.00 @ 180 / 43.50 @ 090.
The spherical rigid lens centers and moves well; the fluorescein pattern shows alignment.
Vision
Streaks around lights at night
“At night I see streaks and glare around headlights and streetlights.”
What you find
Rigid lens with a small optic zone.
The lens rides low, so its edge crosses the pupil.
Pupils are large in dim light.
Lens care
Burning the moment the lens goes in
“It burned like crazy as soon as I put my lenses in this morning.”
What you find
Started a hydrogen peroxide system last night.
Stored the lenses overnight in the flat case left over from the old solution.
Lens care
“I just add a little solution each night”
“To make the bottle last, I just top up the case with a bit of fresh solution each night.”
What you find
Multipurpose solution user.
Rinses the case with tap water in the morning.
Eyes healthy today.
Lens care
Red, gritty eyes after a new solution
“Since I switched to a cheaper solution, both eyes are red and gritty soon after I put the lenses in.”
What you find
Both eyes affected.
Fine, diffuse punctate staining across the whole cornea.
Lens fit unchanged: good centration and movement.
Lens care
Film on the lenses and hazy vision
“My lenses look cloudy and my vision gets hazy, even though I clean them.”
What you find
Monthly replacement lenses, now in their sixth week.
White filmy protein deposits on the lens surface.
Patient soaks the lenses but does not rub them.
Eye health
Itchy, stringy mucus, lens rides up
“My eyes itch, there’s stringy mucus in the morning, and my lenses slide up when I blink.”
What you find
Large bumps on the conjunctiva under the upper lid.
Heavy deposits on the lenses.
Lenses often worn well past their replacement date.
Eye health
Dry, red patches beside a rigid lens
“My eyes feel dry and look red on the sides, near the corners.”
What you find
Rigid lens that rides low with a thick edge.
Staining of the cornea at 3 and 9 o’clock.
Incomplete blinks.
Eye health
Halos, redness and glasses that seem “off”
“My eyes are red most days, lights have halos, and my glasses are blurry for a while after I take the lenses out.”
What you find
Sleeps in daily-wear, low-Dk hydrogel lenses several nights a week.
New blood vessels growing in from the limbus.
Mild corneal haze.
Eye health
A painful red eye that is getting worse
“Since yesterday my eye is more and more painful and light hurts. I think I see a white spot.”
What you find
Soft lens wearer who often naps and swims in lenses.
Red eye, light sensitivity, reduced vision in that eye.
Rigid lens fit
Long-time hard lens wearer, glasses always blurry
“I have worn hard lenses for 25 years. When I switch to my glasses, I can’t see well for hours.”
What you find
The lenses are PMMA.
Corneal edema and some distortion of the keratometer mires.