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Designer cosmetic contact lenses are increasingly popular. As with prescription contact lenses, the complications range from self-limiting to sight-threatening.
A man aged 24 attended eye casualty with irritation and discomfort in both eyes. His vision was 6/6 in the left and no light perception in the right, this being due to a past injury with consequent traumatic cataract and retinal detachment. Two months earlier he had paid £280 for a pair of 'football' designer contact lenses to hide the white reflex from his right cataract. They were purchased over the counter and were not properly fitted. He said he had been given no advice.
Since he had been unable to remove the contact lenses himself, they had been in situ continuously for two months (Figure 1). Attempts to remove the contact lenses at slit lamp examination were unsuccessful despite instillation of topical anaesthetic drops. Eventually, they had to be removed under general anaesthesia. On examination of the corneas there were no contact-lens-related complications. He was counselled on the importance of proper contact lens fitting and aftercare.
Four months later he returned to eye casualty with the same symptoms. He had put the contact lenses back in his eyes almost immediately after discharge and they had remained there continuously ever since. This time, we managed to remove the contact lenses at the slit lamp. There were two corneal abrasions in the left eye due to contact lens overwear, and he was treated with topical ofloxacin drops and chloramphenicol ointment. Examination of the contact lenses by the microbiology department revealed Gram-positive cocci on microscopy but no bacterial, acanthamoeba, or fungal growth. On review five days later, the corneal abrasions had healed without serious sequelae. We strongly reiterated our advice regarding contact lens wear before discharging him again.
Of contact lens wearers, about 6% experience a complication in the course of a year.1,2 The risk increases with certain pre-existing eye conditions and with non-adherence to approved care regimens.2,3 Contact-lens cases can also be a source of contamination and should be cleaned and disinfected regularly.4 It is good practice for eye care professionals to see contact lens wearers at intervals to review and discuss replacement schedules, cleaning regimens, and complications2—not least because wearers regard their eye care practitioner as the most important source of advice on hygiene and care.5 Even then, many do not heed instructions.6
Designer cosmetic contact lenses are easily available and come in a variety of colours and designs. Sales in the UK have increased fourfold over the past year. In contrast to refractive contact lenses, which have to be prescribed and dispensed by qualified eye care professionals, cosmetic lenses can be sold by anyone over the counter without fitting or advice on aftercare. At present there are no regulations in the UK covering their sale.
Complications from contact lens wear are the same whether their purpose is refractive, therapeutic, or cosmetic. In the USA an article has highlighted the ocular complications of wearing non-prescribed cosmetic contact lenses bought through unlicensed sellers,7 and the Food and Drug Administration has warned of the dangers. There have been no such warnings in the UK.
Our patient bought a pair of designer football contact lenses to improve the cosmetic appearance of his right eye. The opportunity for review and education did not arise, since there were no follow-up visits, and he was not aware of the potential complications of leaving non-extended-wear contact lenses in situ for several months. In his case, proper fitting and aftercare was particularly desirable since a serious complication in his seeing eye would have caused devastating visual morbidity. All contact lenses should be properly fitted and cared for according to the approved regimens.