Contraindications to Contact Lenses
By Kelly Harris

Not all patients are the best candidates for contact lenses. Keep these contraindications in mind when working with new contact lens wearers.

Motivation (or lack of it) is a definite contraindication to contact lens wear. A new patient who is not highly motivated will almost always be a fitting failure. Be sure that the patient himself, not Mom or a good friend, wants to wear contact lenses.

Lack of motivation goes hand-in-hand with the patient whose expectations are not realistic, especially, new bifocal and multifocal contact lens wearers. Setting the ground rules for the highly expectant patient will help tremendously. Every detail should be explained to the patient at the very first visit, such as what to expect during the fitting process, wearing time, why glasses in some instances will provide better vision than contact lenses, etc.

Another contraindication high on my list is keratitis sicca (dry eye). Even though some contact lens materials are better for the dry eye patient, working with dry eye patients can be time consuming and not always successful. Mild to moderately dry-eyed patients may succeed; patients with severe dry eye probably will not. Of course, some dry eye patients are willing to wear their lenses on a part-time basis or just for social occasions. The fitter should always provide samples of a rewetting drop at the dispensing visit.

Some medications, systemic and topical, are directly and/or indirectly responsible for contact lens intolerance. Symptoms range from ocular dryness to discomfort and decreased vision. Some may even cause photophobia (light sensitivity). Some medications can cause a reduction in blink rate, such as antihistamines, muscle relaxers, antidepressants and tranquilizers. The fitter should always ask for medication information when taking the complete history. Then explain to the patient what may happen because of the contraindication.

Certain occupations can be contraindication to contact lenses. Mechanics work around a lot of grease, oil and fumes. Their fingers are never quite clean and are very rough. Soft lenses are definitely not a good choice. Construction workers battle the elements and flying debris. GP contact lenses and flying debris in the workplace do not work well together. However, wearing lenses after working hours for sports and social wear should not be a problem.

Long fingernails are a definite contraindication. I often wonder how a new patient thinks she will remove her lenses (especially soft) lenses with long talons. I always keep nail clippers and a file in the dispensing room just in case.