Cosmetic contact lenses were originally designed for people who had disfiguring abnormalities of the iris and cornea; they are now also regularly worn by people who have normal, healthy eyes for cosmetic transformation (Abdelkader, 2014; Singh et al, 2012). Decorative lenses, like contact lenses prescribed for vision correction, are classified by the U.S. Food and Drug Administration (FDA) as medical devices. Thus, an eye examination and valid prescription are needed just as they are for any type of contact lens.

Many Patients View Cosmetic Lenses as Just Cosmetics

Unfortunately, many patients are not aware that cosmetic contact lenses are medical devices. In an online survey of practitioner perceptions of patients wearing decorative contact lenses (Gaiser et al, 2017), patient complications from decorative contact lenses purchased both legally and illegally from unauthorized sellers were reported from 77% of the respondents. Patients aged 18 to 25 years experienced 61% of the complications. One-third of complications were experienced in first-time contact lens wearers; half of these wearers did not receive proper care and handling instructions nor were they aware that care instructions existed. The most common locations of decorative lens purchases were unlicensed stores (25%).

A cross-sectional, anonymous, self-administered survey evaluated the use, knowledge, and complications of cosmetic contact lenses in women of reproductive age (Berenson et al, 2019). Among the participants, knowledge scores were low, and the majority of cosmetic lens users experienced complications (61%). Eye pain and discomfort (35%) were the most frequently reported complications, followed by itchy, watery eyes (34%) and red, swollen eyes (28%). Eighty-eight percent of participants who borrowed contact lenses from others experienced medical complications. Among those who sought medical attention for a cosmetic lens-related problem, only 11% obtained care within 24 hours. Of interest, few participants had discussed cosmetic contact lens use with an eyecare professional in the previous year. The authors suggest that interventions are needed to educate the public about the risk of cosmetic lens use to reduce adverse outcomes.

In a case series of 12 novice contact lens wearers who were evaluated urgently for acute eye pain and redness after wearing plano decorative contact lenses, none of the contact lenses were dispensed by eyecare professionals (Steinemann et al, 2005). Four patients developed blinding infections that necessitated hospital admission. One patient required a penetrating keratoplasty.

Steps for Safer Lens Wear

It is pertinent to review handling with all contact lens wearers and to remind patients of tips for safe contact lens wear (Zimmerman et al, 2017; Centers for Disease Control and Prevention, 2015). Tips include to wash and dry hands prior to handling contact lenses, avoid exposing lenses and cases to tap water, avoid eye rubbing when wearing contact lenses, and replace contact lens care solution daily (do not top off).

Explain to all patients and to the public that contact lenses are medical devices that require a valid prescription. If adverse events occur, report them. If illegal sales of contact lenses are suspected or if any adverse events from illegal contact lenses are detected, it is important to report these activities to and to MedWatch, the FDA Safety Information and Adverse Event Reporting program ( ).

Beyond contact lenses, we need to educate the public about the importance of regular eye examinations. Outside of maintaining ocular health and vision, many systemic conditions can be detected through an eye examination. CLS

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