Contacts lost in eye not such a rare thing-but 27?

Patients with a contact lens lost in the eye are not a rare occurrence for ophthalmologists. However, 27 lenses at the same time may be another story!

The case of a 67-year-old female who had 27 disposable contacts in her right eye discovered just prior to cataract surgery was recently published in the BMJ. The patient had not complained about any severe eye discomfort.

Seventeen of the lenses formed together in a blue mass, which Dr. Richard Crombie, a consultant anesthetist at the Solihull Hospital, United Kingdom, discovered while he was preparing the eye for surgery. The other 10 lenses were found during an additional examination.

Dr. Crombie noticed the blue mass under the upper eyelid while applying the anesthetic, said Dr. Rupal Morjaria, an ophthalmic specialist trainee and lead author of the paper.

“It’s important to stress that people should realize that contact lenses are prescribed medical devices and need to be treated with respect,” said Thomas Steinemann, MD, clinical spokesperson for the American Academy of Ophthalmology (AAO), and professor of ophthalmology, Case Western Reserve University, Cleveland. “If you do that and you take care of your eyes, you’re not going to get into trouble.”

The patient in this case had been wearing contact lenses for over 35 years. When she tried to remove a lens from her eye and couldn’t find it, she assumed she dropped it and would put in another lens.

After removal of the lenses, the cataract surgery was postponed for two weeks.

“This is an opportunity to examine [patients’] own habits about how they wear and care for their contact lenses,” Dr. Steinemann said. “Properly done, contact lenses are a great way of correcting vision.”

Not the first case

Though 27 contact lenses may be a record for lenses stuck in an eye, it is not rare for a lens to be lost in the eye, said Kevin Hinshaw, MD, Eye Specialists of West County, St. Louis. “I don’t think it’s terribly uncommon,” Dr. Hinshaw added, “but you shouldn’t be finding that out on the [operating] table.”

Multiple low power lenses are more likely to go unnoticed, he pointed out.

5 lost lenses

Every year, Dr. Hinshaw said a few of his patients will present with a full or a fragment lens lost in the eye. The difficult ones to find are single lenses that roll up like a cigar, which is quite painful, he said.

However, one of Dr. Hinshaw’s patients had five lenses lost in the eye. In cases like these, “(the patients) don’t realize they’ve become blinded in one eye.”

In the case of the patient with 27 lenses, Dr. Hinshaw said part of the reason she could have not been in severe discomfort is because contact lenses today are advanced. “We’re in the era of 100% oxygen permeable lenses,” he added. “These lenses are transparent to oxygen…and don’t impede the oxygen getting the cornea.”

While contact lens wearers do not need to be fearful of this sort of occurrence, Dr. Hinshaw said it raises awareness of it happening. When in doubt of whether a lens should be removed, patients are reminded to see their eye care provider.

In terms of why this patient was not discovered until preop, Dr. Hinshaw said a standard ophthalmic exam would have revealed the lenses or at least raised the question.

Surgeons also should not accept mucus in the eye, or dried mucus in the corner of the eye, as a normal occurrence, he advised.  “It’s a defense mechanism to coat the lens-mucus doesn’t just show up for no reason,” Dr. Hinshaw added.

In cases where Dr. Hinshaw suspected a lost contact lens in the eye and could not find it, he will use a Desmarres lid retractor, put fluorescein in the eye, and have the patient look down.

If a patient comes in with discomfort, saying the lens fell out, there is still reason to suspect a lost lens or lens fragment in the eye, then conduct a thorough examination.

“Don’t take their word for it,” he said.

Loss of sensitivity

Loss of sensitivity

Dr. Steinemann explained that continued contact lens wear over time can cause eyes to become less sensitive, and it is possible the discomfort from the clumped lenses was confused with dry eye symptoms in this U.K. case. An earlier visit to an eye care specialist could have detected this issue sooner.

Dr. Steinemann pointed out that contact lens wearers should see an eye care provider annually.

“Contact lenses-even in the best of circumstances in patients with a lot of lens wear experience-can cause chronic changes that need to be monitored,” Dr. Steinemann said.

Physicians should treat patient calls with a higher level of suspicion if they know the patient has a history with contact lens-related complaints.

“Contact lenses are a wonderful way to correct vision, but safe is relative,” he said. “It is largely dependent on the wearer taking ownership in proper care. There’s no such thing as absolute safety.”

Consistent reminders for patients, such as not to sleep with their contacts and know when to discard lenses, are key.  “Follow the rules of the road,” Dr. Steinemann said. “There’s a reason why those guidelines are established.”

Neither Dr. Steinemann nor Dr. Hinshaw had any financial interests to disclose pertaining to this subject matter.