If you’ve relied on contact lenses for an extended time, it’s possible to develop some form of contact lens intolerance.

As a teenager or college student, you may have contact lenses in for hours and hours and have no problems or discomfort. However, as you age, you may find it difficult to make it through an entire workday. What gives? Let’s take a look at the issue now known as contact lens intolerance.

What is contact lens intolerance?

Contact lens intolerance is a term used to describe the eye’s inability to tolerate the contact lens and the clinical signs of lens intolerance: pain, discomfort, or irritation.

What are the symptoms of contact lens intolerance?

Contact lens intolerance may occur daily or as a result of seasonal allergies. Symptoms can range from mild to severe. Common symptoms of contact lens intolerance include:

• Dryness
• Itching
• Redness
• Irritation
• Pain
• Eye infections
• Eye abrasions

What are the causes of contact lens intolerance?

Improper wear of the lenses, inadequate cleaning techniques, and ocular conditions like allergies and dry eye are the most common causes of contact lens intolerance.

Reactions to contact lens solution

Some patients may have allergies or lens insensitivity to different preservatives or agents in contact lens solutions. If you develop problems with your contacts, be sure to discuss the brand of lens cleaning solution you are using with your doctor.

As patents expire, generic solutions can be substituted year to year and may not be the same cleaning agent you have used in the past. Lens solution changes can result in itching, redness, or more severe complications like corneal infiltrates.

Improper wear of contact lenses

Patients who overwear their lenses are at risk for developing contact lens intolerance. Each type and brand of lens has been approved for a specific wear time based on the material. Patients who wear a biweekly lens for a month or those who wear a monthly lens for longer than a month may develop eye symptoms. Often patients admit to overwearing their lenses during a certain time in their life and suffer the effects later.

Dry eye

Patients may develop dry eye from environmental conditions, systemic medications, and/or digital device use. Age, autoimmune conditions, and simply being female are risk factors for developing dry eye. If you are suffering from dry eye, lifestyle modifications or dry eye treatments may improve the comfort of your eyes and enable you to wear contact lenses again.

Allergic conjunctivitis

Allergic conjunctivitis is caused by the adherence of environmental allergens to your contact lenses or just environmental exposure. In some regions, patients may suffer year-round from allergies, but conditions worsen in the spring and fall. 

Many pet owners are allergic to their animals. Instead of having to give up your pet, having a discussion with an eye doctor about your allergies may yield a treatment plan so you can enjoy your furry friends.

Lens material intolerance

If you’ve been wearing the same type of contact lens for years, your lens technology could be outdated. Wearing outdated contact lens brands made from older materials can lead to contact lens intolerance. Historically, lens materials were less breathable, meaning less oxygen reaches your corneas. If you were to sleep in these older material lenses or wear them for extended hours, it could lead to problematic eye conditions or pathologies. Be sure to discuss your contact lens technology with your eye doctor.

Poor lens fit

An eye doctor will assess your contact lenses each year. We call this a contact lens evaluation or “fitting.” Doctors evaluate the fit of the lens on the eye, the tear film underneath the lens, and the health of the cornea and surrounding blood vessels and tissue.

Solutions for contact lens intolerance

Solutions for contact lens intolerance include:

Change wearing schedule

After treating the ocular condition, changing the patient’s lens wear schedule is the best solution for reducing contact lens intolerance.

Many lens wearers are in a monthly modality and may be hesitant to change. Even with effective cleaning and hygiene, lenses become dirtier and more uncomfortable with longer wear times. Most contact lens wearers will agree a new, fresh lens always feels better on the eye than one worn for weeks. Environmental pollutants, allergens, or even fabric or paper particles in an office setting can accumulate on a lens over time. These particles may cause discomfort and even blurry vision.

Change lens solution

Most contact lens wearers use a multipurpose lens cleaner, but don’t read the package inserts, and clean the lenses properly. Without the rinse step, protein may build up on the surface of the lens resulting in blurry vision or an ocular inflammatory condition called giant papillary conjunctivitis (GPC).

Doctors describe this condition as bumps underneath the lids that cause the lens to move around in the eye or cause eye discomfort when the patient takes the lens out at the end of the day. Doctors may prescribe a hydrogen peroxide-based solution for these patients.

A hydrogen peroxide solution has proven to be the best cleaning solution for patients who wear their lenses for more than a day. When compared to a multipurpose cleaner, hydrogen peroxide solutions have better compliance, improved efficacy and eye comfort, and improved eye surface health for contact lens-wearing patients. 

Treat the underlying ocular condition

Often, changing the lens type or solution will not improve contact lens intolerance if the underlying eye conditions are not treated. Your eye doctor will look at your eyes and your eyelids under their microscope to assess if an eye condition is a reason you are unable to wear your contact lenses. Conditions like limbal stem cell deficiency, dry eye, and allergies should be treated prior to changing your lenses or solutions.

Change lens usage

Most patients do not want to permanently give up their contact lenses. Contact lens intolerance may be improved simply by limiting wear time to weekends or removing the lenses at the end of the work day. Substituting eyeglasses for contacts several times per week may improve lens comfort when it is preferred to wear contact lenses.

Contact lens intolerance is frustrating for both doctors and patients. Believe me, we don’t want to take you out of your contact lenses or limit your wear time. It may take several treatments and time out of your lenses to fix the problem. Switching to daily disposable lenses and being compliant with wear time are best practices to avoid the development of contact lens intolerance.