An Eye for an Ear?
When one of my presbyopic GP multifocal patients phoned to report that her lenses had "turned into soft lenses overnight," the whole office had a bit of a chuckle. Although we explained that this just doesn't happen and that perhaps she had mixed them up with her daughter's lenses, the patient insisted, so we scheduled her to come in. Our office policy has always required that patients bring "everything" cases, solutions and lenses when they come in for a contact lens problem evaluation.
This policy paid off as we were able to instantly determine the problem: the patient had mistakenly stored her lenses in ear-drying drops (used for preventing swimmer's ear) instead of her normal conditioning solution. The ear drops are mostly (or at least 50% depending on the formulation) isopropyl alcohol, which in such concentration has solvent properties that are unkind to GP lenses. (If you're curious, take an old lens and fill the case with rubbing alcohol. The lens will expand and become soft just as the patient related.) The lenses were, of course, permanently damaged and needed to be replaced. This incident happened several years ago, and I might have forgotten it altogether were it not for a more recent, disconcerting incident.
Figure 1. It's easy to see how patients
might confuse ear products with eye and contact lens products.
A Second Incident
Recently another presbyopic contact lens patient came into our clinic for an emergency. She reported that she had just been swimming. After leaving the pool, one eye felt irritated so she reached for her lens rewetting drops and mistakenly administered ear drops containing 95% isopropyl alcohol onto her eye. We irrigated the eye and prescribed lubricating eye drops, and instructed her to not wear her contact lenses for several days. The eye was red and uncomfortable for a few days, but resolved without further problem.
Seeing is Believing?
It was easy to see how these patients could make such an error. The packaging and dropper tip of the ear drops closely resemble contact lens product containers (Figure 1), and with no red "warning" tip, it was a simple error to make.
Contact lens product manufacturers use a warning system whereby the dropper tip is red for products that patients shouldn't put in the eye. Most practitioners are savvy enough to point this out to patients, and as a result, many patients have been spared the discomfort of accidentally putting a contact lens cleaning product or hydrogen peroxide on the eye surface. I believe that ear products should employ a similar convention so that incidents such as these occur less frequently. A tip of almost any color other than white could serve to alert patients that the drops they are about to use aren't the eye product they were planning on.
Preventing Further Mishaps
It's my guess that other such cases exist. However, we need to report them to see action taken on this problem. I invite practitioners who have encountered similar experiences involving ear-drying drops to e-mail me with the information. Alternatively, or additionally, you can voluntarily report such incidents as adverse events to the U.S. Food and Drug Administration. Go to www.fda.gov and click on Medwatch. You can complete a form online or download a form to mail in.
Dr. Bergenske, a past chair of the American Academy of Optometry's Section on Cornea and Contact Lenses, has practiced for over 20 years in Wisconsin and now is on the faculty at Pacific University College of Optometry. E-mail him at: firstname.lastname@example.org.