What are the best eye drops for painful eyes after wearing contact lenses?

Eye Drops for Painful Eyes After Wearing Contact Lenses

Immediately remove your contact lenses and do not resume wear until your eyes completely return to normal, then use preservative-free artificial tears or lubricating drops as first-line treatment for symptomatic relief. 1, 2

Immediate Actions Required

• Stop contact lens wear immediately upon experiencing pain, as continuing to wear lenses during active symptoms can lead to serious complications including microbial keratitis 1, 2
• Remove lenses before applying any eye drops, as most formulations require lens removal 3
• Seek urgent ophthalmology evaluation if you experience moderate-to-severe pain, decreased vision, photophobia, or discharge, as these are warning signs of potentially sight-threatening infections 1, 4

First-Line Treatment: Lubricating Drops

Preservative-free artificial tears are the safest and most appropriate initial treatment for contact lens-related eye discomfort 2, 5:

• Apply preservative-free ocular lubricants immediately for symptomatic relief 2
• These drops are safe and effective with minimal impact on the ocular surface 5
• Very low-certainty evidence suggests lubricating drops may reduce contact lens discomfort by approximately 6 points on a 37-point scale compared to no treatment 6
• Oil-in-water emulsion drops (like SYSTANE BALANCE) showed statistically significant improvements in comfort, wearing time, and reduced corneal staining in symptomatic contact lens wearers after 1 month of use 7

Why Avoid Preserved Drops

• Preservative-containing formulations can cause additional allergic contact dermatitis and eye irritation 8, 5
• If preserved drops must be used, avoid benzalkonium chloride or thimerosal-containing products 5
• Hydrogen peroxide lens care systems may be superior to preserved solutions but require more complex care regimens 1, 2

When NOT to Use Certain Eye Drops

Do not use ketotifen or other antihistamine eye drops to treat contact lens-related irritation 3:

• The FDA label for ketotifen explicitly warns against using it "to treat contact lens related irritation" 3
• Wait at least 10 minutes after using ketotifen before reinserting contact lenses 3

Avoid vasoconstrictor drops (like tetrahydrozoline) as a primary treatment:

• While FDA-approved for redness (1-2 drops up to 4 times daily) 9, these only mask symptoms without addressing underlying inflammation
• They do not treat the inflammatory process that contact lens wear intrinsically causes 10

Escalation for Persistent Symptoms

If pain persists beyond 24-48 hours after lens removal and lubricating drop use:

• Mild contact lens-related conjunctivitis: The American Academy of Ophthalmology recommends a brief 1-2 week course of topical corticosteroids 2
• Moderate-to-severe cases: Require ophthalmology referral for possible topical corticosteroids or cyclosporine 0.05% for longer-term inflammation management 2
• Consider tacrolimus 0.1% ointment if eyelid involvement is present, but this requires ophthalmology review within 4 weeks 8

Critical Warning Signs Requiring Immediate Ophthalmology Evaluation

Contact lens wear carries a 10-15 fold increased risk of microbial keratitis with overnight wear 1. Seek immediate care if you experience:

• Moderate or severe pain (suspect Acanthamoeba keratitis, especially with water exposure history) 2, 4
• Vision changes or decreased vision 1, 4
• Increased light sensitivity (photophobia) 1
• Eye discharge 1
• Redness that worsens or persists beyond 72 hours 3

Prevention of Future Episodes

Before resuming contact lens wear after complete resolution:

• Review your contact lens care regimen: never rinse lenses or cases with tap water, bottled water, or homemade saline 1, 2
• Replace contact lens cases every 3 months 1
• Consider switching to daily disposable lenses, which have lower complication rates 1, 2
• Avoid overnight wear, which increases infection risk 5-fold compared to daily wear 2, 4
• Never wear contact lenses while swimming, showering, or in hot tubs 1, 2

Common Pitfalls to Avoid

• Resuming contact lens wear too early before complete symptom resolution leads to recurrence and chronic issues 2
• Using preserved eye drops chronically can worsen symptoms rather than improve them 8, 5
• Ignoring pain as "normal contact lens discomfort" when it may represent serious infection—one-third of contact lens wearers report previous red or painful eye conditions requiring medical evaluation 4
• Continuing to wear lenses during treatment, which prolongs infection and increases complication risk 2