1. Removal of Dislocated Contact Lens
Presentation
The patient may know the lens has dislocated into one of the recesses of the
conjunctiva, and complain only of the loss of refractory correction; or he may have lost
track of the lens completely, in which case the eye is a logical place to look first. Pain
and blepharospasm suggest a corneal abrasion, perhaps from removal attempts.
What to do:
• If pain and blepharospasm are a problem, topically anesthetize the eye.
• Pull back lids as when looking for conjunctival foreign bodies, invert the upper
lid, and, if necessary instill fluorescein dye (a last resort with soft lenses, which
absorb the dye tenaciously).
• If the lens is loose, slide it over the cornea, and let the patient remove it in the
usual manner. Irrigation may loosen a dry, stuck lens.
• For a more adherent hard lens, use a commercially available suction cup lens
remover. Soft lenses may be pinched between fingers or require a commercially
available rubber pincer.
• Put the lens in a proper container (sterile saline is always right).
• Complete the eye examination, including acuity, bright light and fluorescein
examination. Patch the eye if there is a corneal abrasion.
• Instruct the patient not to wear the lens until all symptoms have abated for 24
hours, and to see his ophthalmologist if there are any problems.
What not to do:
• Do not give up too easily. Lost lenses have been excavated years later from
under scar tissue in the conjunctival recesses.
• Don't omit the fluorescein step for fear of spoiling a soft contact lens. The dye
may take a long time to elute out, but it is more important to find the dislocated
lens.
Discussion
The deepest recess in the conjunctiva is under the upper lid, but lenses can lodge
anywhere; there have been rare cases of lenses perforating the conjunctival sac and
migrating posterior to the globe. Be sure to evert the upper conjunctival sac by pushing
down with a cotton tipped applicator.