Contact Lenses in Kids: Best Practices

Monte D. Mills, MD


May 24, 2013

Editorial Collaboration

Medscape &

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Hello. I am Monte Mills, Director of Ophthalmology at the Children's Hospital of Philadelphia. I would like to talk today about the risks of cosmetic or costume decorative contact lenses. These are contact lenses that are not fitted by an ophthalmologist or optometrist; that children and young adults are buying at cosmetic stores, salons, and beauty supply stores; and that change the color of the person's eye or the shape of the pupil or iris when they are worn. These are unregulated by the US Food and Drug Administration (FDA), have not been fitted, are very unsafe; they should not be used by anyone, especially children.

They are potentially toxic to the eye. They have not been fitted properly and so they have a high risk for complications, including serious eye infections and potentially permanent vision loss. Every year at Children's Hospital we see infections and complications related to these lenses in our emergency room and eye clinic, and most of the affected individuals and their parents do not understand the risks of wearing these unfitted and unregulated devices on their eyes.

The risks relate mostly to infection, poor fit, and lack of hygiene, as well as lack of proper instructions. Handling the lens and insertion and removal of the lens leads to a high risk for bacterial corneal infection and also parasitic infection with amoebas. These are very serious infections that we treat when we can. We are able to restore vision in most patients, but [these infections] can lead to permanent vision loss or blindness.

What are some rules for safe contact lens wear? First, contact lenses should only be used to correct the patient's vision and not as a costume or for a decoration. They need to be fitted by a professional -- an optometrist, ophthalmologist, or optician -- who is skilled and licensed in the fitting of contact lenses. The lens should be one that has been approved by the FDA for use in humans. The lenses need to be fitted properly and the patient needs to be instructed on the proper technique for insertion, wearing, sterilization, and cleansing of the lens and storage case. Finally, those rules have to be followed carefully.

Lenses should never be worn overnight. Other high-risk use of lenses would be wearing lenses for swimming or other activities in which water or contamination would be splashed into the eyes. If a child or an adult has a red eye or a painful episode related to contact lens use, the lens should be removed immediately and the patient, along with the lens, should be sent immediately to an emergency room or, on the same day, to an eye professional to be evaluated for possible infection and started on treatment.

Those are some of the rules for safe contact lens use, but I would strongly advise that no decorative or purely cosmetic, costume contact lenses ever be used or be considered safe unless they are fitted by a professional.