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Contact Lens Keratitis: Prevention and Treatment
How Contact Lens Habits Raise Your Risk
Most cases of contact lens keratitis are connected to specific behaviors that are entirely within your control. Understanding which habits create the highest risk is the first step toward protecting your corneas. Our eye doctors encourage every lens wearer to review these risk factors regularly.
Wearing lenses overnight is one of the highest-risk habits a lens wearer can have. During sleep, tear production slows, which means the natural flushing action that removes germs from the eye surface is reduced. Only certain lens types are specifically designed and approved for overnight wear, and even those carry a higher risk compared to removing lenses at the end of each day.
If your lenses are not labeled for extended or overnight use, they should come out before you sleep. If you are unsure whether your lenses are approved for overnight wear, ask our team at your next visit.
Hands carry bacteria and other germs. Touching your lenses without washing your hands thoroughly first transfers those germs directly onto the lens surface and into your eye. Always wash your hands with soap and water and dry them with a clean towel before handling any lens.
Your lens case is equally important. Cases can harbor germs in the solution that pools inside. Rinse your case with fresh lens solution after each use, never with tap water. Let it air dry face down on a clean tissue. Replace your case at least every three months, or sooner if it shows any discoloration or buildup.
Adding fresh solution on top of old solution in a case is a common and risky habit. The old solution dilutes and weakens the fresh product, leaving germs that were already present free to grow. Each time you store your lenses, empty the case completely and refill it with fresh solution.
Always use a solution that is compatible with your specific lens type. Tap water, saliva, and homemade saline are not safe substitutes and have been directly linked to serious corneal infections, including Acanthamoeba keratitis.
Tap water is a known source of Acanthamoeba and should never come into contact with your lenses or case. Remove your lenses before showering, swimming, or using a hot tub. If water does get on your lenses, the safest choice is to remove and discard them immediately rather than continue wearing them.
If swimming with lenses is unavoidable, wearing tightly sealed watertight goggles can reduce, though not fully eliminate, the risk. Even then, lenses should be removed and discarded as soon as possible after the activity.
Warning Signs You Should Not Ignore
Corneal infections can progress quickly. Recognizing the early warning signs and acting fast can make a significant difference in how well the eye heals. Our eye doctors want patients to know that some infections can worsen in a matter of hours, and same-day care is often essential.
A comfortable, well-fitting contact lens should not cause pain. Any sharp, aching, or persistent pain in the eye is a signal to remove your lens immediately. If the pain does not ease within a few hours after lens removal, contact our office the same day.
Pain that feels severe even when the eye looks only mildly red is a classic pattern in Acanthamoeba keratitis. Do not dismiss pain simply because the eye does not appear badly inflamed on the outside.
A red eye that stays red or worsens after you remove your lens needs to be evaluated the same day. Light sensitivity, also called photophobia, is another important warning sign. If bright light causes significant discomfort or you find yourself squinting indoors, that is your eye telling you something is wrong.
Over-the-counter lubricating drops will not treat an infection. Do not attempt to manage these symptoms at home and hope they resolve on their own. Reach out to our office or an urgent eye care provider right away.
Blurry vision that does not clear when you switch to glasses is a red flag for a corneal problem. Thick or unusual discharge from the eye is another warning sign that should not be ignored. A white or gray spot visible on the colored part of the eye, seen in a mirror or noticed by someone else, is a particularly serious finding that requires same-day evaluation.
Any combination of pain, redness, light sensitivity, blurred vision, or discharge in a contact lens wearer warrants urgent care. Do not wait to see if the eye improves on its own. If our office is not available, an emergency room with ophthalmology coverage is the appropriate next step.
Fast treatment can often preserve full vision. Delay can result in corneal scarring, lasting visual blur, or in severe cases, the need for a corneal transplant.
How Contact Lens Keratitis Is Treated
Treatment depends on the type of germ involved, the size and location of the ulcer, and how quickly care begins. Our eye doctors will examine your cornea carefully and create a treatment plan suited to your specific infection. Early, accurate treatment gives the cornea the best chance to heal without lasting damage.
At your first visit, our team will examine your cornea using a slit-lamp microscope, which provides a highly magnified view of the eye's surface. A dye drop called fluorescein is used to highlight any ulcers or areas of damage on the cornea. For larger, deeper, or more concerning ulcers, a small sample may be taken from the corneal surface to identify the specific germ under laboratory testing.
Culture results typically take one to two days to return but are very helpful in directing treatment for difficult or slow-healing cases.
Most bacterial corneal infections are treated with prescription antibiotic eye drops. In the early phase of treatment, drops are often applied very frequently, sometimes every 30 to 60 minutes during waking hours. A class of antibiotics called fluoroquinolones is commonly used as a first-line treatment because of its broad effectiveness against many bacteria.
In more severe cases, two different antibiotic drops may be used together to target the infection from different directions. These are sometimes referred to as fortified antibiotic drops and are prepared at a compounding pharmacy for each patient. The dosing schedule is adjusted as the cornea responds to treatment.
Fungal corneal infections require antifungal eye drops, and Acanthamoeba infections require a specialized antiseptic drop. Both types of infection respond more slowly than bacterial infections, and treatment may continue for several months. Frequent follow-up visits are essential to monitor progress.
If you have worn lenses while swimming, showering, or soaking in a hot tub, let our team know right away. This information helps us evaluate your risk for Acanthamoeba keratitis from the very beginning of your care.
During the healing period, you will have several close follow-up appointments so our team can monitor the ulcer and adjust your drops as needed. As the cornea heals, a bandage contact lens may be placed over the eye to provide comfort and support the healing surface. This is different from a standard vision-correcting lens.
You should discard all lenses, your lens case, and any open solution that you were using when the infection developed. Once your eye has fully healed and our team clears you to resume lens wear, we will work with you on a proper fit and review safe care habits going forward.
Frequently Asked Questions
These answers address the questions our eye doctors hear most often from patients who want to wear lenses safely or who are concerned about a current eye problem.
Daily disposable lenses do carry a lower infection risk compared to reusable lenses because you use a fresh, sterile lens each day and discard it at night. There is no case to clean, no solution to store, and no chance of solution contamination building up over time. For patients who have had a previous lens-related infection or who struggle with consistent cleaning routines, daily disposables are often the lens our team recommends.
No. Tap water should never be used to rinse, store, or clean contact lenses or lens cases. It can contain Acanthamoeba and other organisms that cause severe corneal infections. If you run out of solution, the safest option is to discard the lens entirely rather than expose it to tap water. Keeping a small travel bottle of lens solution in your bag is a practical way to avoid this situation.
Some corneal infections can worsen within hours, especially those caused by Pseudomonas aeruginosa. This is why same-day care is so important once warning signs appear. A small early ulcer is much easier to treat than one that has spread deeper into the cornea overnight. If you notice any combination of pain, redness, light sensitivity, or vision changes, act immediately rather than waiting to see if it improves.
Most people who receive prompt treatment for corneal keratitis heal without needing a transplant. A corneal graft, also called a penetrating keratoplasty, is typically only considered when a deep scar is significantly blocking vision or when the corneal tissue itself is severely compromised. Seeking care at the first sign of infection is the single most effective way to reduce the chance of needing surgical intervention.
Teenagers can wear contact lenses safely when they are committed to proper hygiene. Daily disposable lenses are a particularly practical option for this age group because they eliminate the need for daily cleaning routines and case maintenance. Parents should stay involved by watching for any signs of redness, pain, or poor compliance with lens care. Any eye discomfort or redness in a teen who wears lenses warrants a prompt exam.
Yes. Mascara and eyeliner can harbor bacteria over time, and applying them with lenses already in place increases the risk of contaminating the lens surface. A few simple steps can reduce this risk significantly: replace eye makeup every three months, insert your lenses before applying makeup, and remove your lenses before taking makeup off at the end of the day. Keeping these steps in order helps prevent the transfer of bacteria from cosmetics onto your lenses or eyes.
Talk to Our Team About Safe Lens Wear
At NewView Eye Center, our eye doctors are experienced in evaluating and treating contact lens-related corneal infections throughout Northern Virginia. Whether you have concerns about your current lens care routine or need urgent evaluation for a painful or red eye, we are here to help you protect your vision and keep your eyes healthy. We encourage you to reach out to our team at the first sign of any problem, because acting quickly is always the right choice when it comes to your eye health.
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