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The Emergency Physician must be familiar with the proper technique of removing both soft and hard contact lenses from patients who are unable to do so for various reasons. Patients with altered mental status are at particular risk of corneal damage if contact lenses are allowed to remain in place. Healthy individuals who wear contact lenses overnight experience a 4 to 15 fold increase in the risk of corneal injury over those who remove their contact lenses daily.1 The explanation for this increased risk focuses on corneal hypoxia and an immune response to antigens present on the lens surface, both of which lead to an inflammatory response and susceptibility to infectious organisms.1 This results in an increased incidence of ulcerative keratitis and Pseudomonas aeruginosa infection.2


Contact lenses rest on a three-layer tear film (outer lipid, middle aqueous, and inner mucus layer) that covers the corneal and conjunctival epithelium. This tear layer provides oxygen and nutrients to the avascular cornea. The cornea also receives nutrition from blood vessels at the limbus and the aqueous humor. It is believed that contact lenses increase tear evaporation and disrupt the three-layer tear film, leading to the lack of corneal oxygenation and the symptoms of dry eye.3 A dry eye causes discomfort and corneal edema with resultant hazy vision. The normal blinking action causes contact lens movement and a “fresh” flow of oxygenated tears over the cornea in the awake patient. This is obviously not present in the sleeping or comatose patient.


The normal resting position of the contact lens is over the cornea. It may occasionally drift from the center of the eye and relocate over the sclera or in various parts of the eye, including under the upper eyelid. Explore all aspects of the eye, including under the upper and lower eyelid margins, when evaluating an individual for contact lens removal.


Contact lenses must be removed from any patient who is unconscious or suffers an ocular injury. Lenses should not be left in place if fluorescein stain is to be used to examine the eye. Fluorescein can permanently stain the lens material. Give patients the opportunity to remove their own contact lenses if there are no contraindications (i.e., immobilization, ocular trauma, etc.).


The only absolute contraindication to removing a contact lens would be in the case of a ruptured globe. Leave the contact lens in place for the Ophthalmologist to remove at the time of their examination and/or surgical repair. Extreme caution must be exercised to avoid unnecessary pressure on the eye itself so as not to complicate the injury when severe ocular damage has occurred.


  • Normal saline
  • Two cups, labeled left and right
  • Hard lens remover suction cup device, optional
  • Soft lens remover device, optional
  • Cotton-tipped applicators


Instruct the patient to remove their contact lenses if there are no contraindications. Patients are usually quite adept at removing ...

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