Removing a Stuck Contact Lens from the Eye
For a stuck contact lens, first irrigate the eye with sterile saline or tap water to allow natural tears to flush it out, and if unsuccessful, the lens must be removed immediately by a healthcare provider using topical anesthesia and direct visualization under slit-lamp examination. 1, 2
Immediate Actions
- Do not rub the eye, as this can embed the lens deeper or cause corneal abrasion 2
- Irrigate with sterile saline, tap water, or commercial eye wash solution to help flush the lens 1, 2
- Allow natural tears to work by blinking repeatedly while looking in different directions 2
- Shield the eye with a hard plastic eye shield, paper cup, or plastic cup to prevent unintentional touching if the lens remains stuck 1, 2
When Home Removal Fails - Seek Immediate Medical Attention
Contact lens-related foreign body sensation requires immediate medical attention, including removal of the contact lens and discontinuation of use 2, 3
The American Academy of Ophthalmology mandates that contact lens wear at the time of injury requires immediate lens removal and discontinuation 1, 3
Medical Removal Procedure
Initial Assessment
- Test visual acuity immediately to establish baseline function 1, 3
- Perform slit-lamp biomicroscopy to evaluate the corneal epithelium for defects, location of the lens, and depth 1, 3
- Use fluorescein staining to identify any epithelial defects caused by the stuck lens 1, 3
- Evert the eyelid to inspect the tarsal conjunctiva, as contact lenses can become lodged under the upper lid 1
Removal Technique
- Apply topical anesthesia before attempting removal 4
- Remove the lens under direct visualization using slit-lamp guidance 3
- Irrigate copiously with sterile saline during and after removal 1
Post-Removal Treatment
- Broad-spectrum topical antibiotic prophylaxis (moxifloxacin four times daily or gatifloxacin) is mandatory after removal 1, 3
- Topical NSAID (ketorolac) for pain, photophobia, and foreign body sensation 1, 3
- Cycloplegic agent (cyclopentolate) to reduce ciliary spasm pain 1, 3
- Oral acetaminophen or NSAIDs for additional pain relief 1, 2, 3
Critical Red Flags Requiring Emergency Ophthalmology Referral
- Vision loss or acute decrease in visual acuity 1, 3
- Irregular pupil after the incident 1, 3
- Eye bleeding 1, 3
- Visible corneal damage with ulceration, haze, opacity, or purulent discharge 1, 3
- Moderate-to-severe pain and photophobia 1
Important Pitfall to Avoid
Test corneal sensitivity in all contact lens-related injuries. A case report demonstrated that corneal anesthesia combined with delayed removal and anti-inflammatory use led to corneal melting and perforation 5. Corneal sensitivity should be documented, as anesthesia is an important risk factor that enhances corneal complications 5.
Mandatory Follow-Up
- All patients require ophthalmology follow-up within 24-48 hours after contact lens removal to monitor for infection 1, 3
- Return immediately if experiencing worsening pain or vision, increasing redness, discharge or purulent material, or persistent foreign body sensation despite treatment 1, 3
- Discontinue contact lens use until cleared by ophthalmology 2, 3