How to put in and remove contact lenses: a step-by-step method

Putting in a contact lens comes down to five steps: wash and dry your hands, check which way round the lens is, hold your eyelids, place the lens on the eye while looking up, then blink. To remove it, slide it downwards and gently pinch it out if it is soft, or lift it out with a small suction tool if it is rigid. In the first few days, the technique calls for patience, not force. Three rules matter as much as the technique: never water, never overnight with daytime lenses in, never beyond the intended wearing period. And a red or painful eye while wearing a lens means removing the lens and seeing an ophthalmologist the same day or, failing that, going to the eye emergency department.

BEFORE YOU START

Your hands first, then which way round the lens is

Everything starts at the washbasin. Wash your hands with soap, rinse them, then dry them with a clean, lint-free towel: a single drop of tap water on your finger is enough to contaminate the lens. In a study of daily disposable lens wearers in Australia and New Zealand (Stapleton, 2017), less frequent hand washing increased the risk of corneal infection 1.8-fold. Short nails avoid scratching the lens or injuring the eye. Put the plug in the basin: a lens that falls down the plughole is lost.

Before putting in a soft lens, check which way round it is. Resting on the pad of your index finger, a lens the right way round forms a bowl with nicely upright edges, like a half-sphere. Inside out, its edges flare outwards, like a soup plate. An inside-out lens will not injure the eye, but it moves, stings and gives less sharp vision. Also check that it is intact, with no cracks or deposits: if in the slightest doubt, throw it away.

How to put in contact lenses, step by step

It is usual practice to always start with the same eye, the right one, so that the two lenses are never swapped when the prescriptions differ. The method is the same for a soft lens and for a rigid lens, with a few differences.

1. Take the lens out of its case or blister pack with the pad of your index finger, never with your nail. Rinse it with the care solution if it comes from the case.
2. Place it on the tip of the index finger of your dominant hand, without too much liquid: a lens floating in a drop slides about and flips over.
3. Hold your eyelids. The middle finger of the same hand pulls down the lower eyelid; the index or middle finger of the other hand lifts the upper eyelid, holding it by the lashes against the brow bone, which stops you from blinking.
4. Look up or straight ahead, and bring the lens smoothly towards the eye until it touches it. It settles on the eye by itself, through capillary action: there is no need to press.
5. Release the lower eyelid first, then the upper one, close your eye and blink gently a few times: the lens centres itself.

A rigid lens, smaller and more steeply curved, is placed directly on the cornea, with the eye looking straight ahead into the mirror, and the eyelids are released even more slowly. If it slips off-centre onto the white of the eye, you bring it back by looking in its direction and pushing gently through the eyelid. A lens that has been dropped is never put back in as it is: a daily disposable is thrown away, a reusable lens is cleaned and disinfected before being put in again.

How to remove your contact lenses

Wash and dry your hands again. Removal, too, is always done in the same order, right eye then left eye, and each lens goes into the compartment of the case that matches it.

Soft lens: slide it, then pinch it

Look up. Your middle finger pulls down the lower eyelid. With the pad of your index finger, touch the lower part of the lens and slide it downwards onto the white of the eye, which is less sensitive than the cornea. Then gently pinch it between your index finger and thumb: it folds and comes away. If it seems stuck, most often it is because it has dried out: a drop of preservative-free artificial tears, a few blinks, and removal becomes easy. Never pinch on the cornea, never with your nails.

Rigid lens: the suction tool or the blink

A rigid lens is not pinched. The simplest method is the small suction tool supplied with the lenses: moistened with solution, it is placed on the centre of the lens, slightly at an angle, and removes it with a tilting movement. The other method, taught during the fitting: stretch the skin at the outer corner of the eye with one finger, look straight ahead and blink firmly; the eyelids push the lens out, while your other hand waits, cupped, above a towel.

MISTAKES

Common mistakes and what they cost

Almost everyone makes them. In the 2014 survey by the US Centers for Disease Control and Prevention (Cope, 2015), about 99% of wearers reported at least one risk behaviour, and nearly a third had already sought medical care for a red or painful eye related to their lenses. A Texas study (Robertson, 2011) measures the gap between perception and fact: 85% of wearers considered themselves compliant, 0.4% fully were.

• Water. Rinsing a lens or its case in tap water, showering or swimming with lenses in, handling them with wet hands: a 2019 review (Arshad) calls for any exposure to water to be avoided, with swimming acceptable only with watertight swimming goggles. Water can contain amoebae, which cause Acanthamoeba keratitis, a rare infection but one that takes a very long time to treat; the British study of the 2011-2017 outbreak (Carnt, 2018) includes among its risk factors inadequate hand and lens hygiene and wearing lenses while swimming or bathing.
• Nights. Sleeping in your lenses, even for a nap, deprives the cornea of oxygen and multiplies the risk of infection: 5.4-fold in the Moorfields study (Dart, 2008), whatever the type of lens. In an Australian study (Stapleton, 2008), overnight wear of soft lenses gave 19.5 cases of infection per 10,000 wearers per year, compared with 1.9 for daytime wear. Details in sleeping in your contact lenses.
• Wearing period. A daily disposable is thrown away the same evening. In a survey carried out in four countries (Dumbleton, 2013), 9% of daily disposable wearers reused them, mainly to save money, at the cost of reduced comfort. Wearing a monthly lens beyond its month means wearing a lens whose deposits no longer come off.
• The case. In the Australian study of moderate and severe keratitis (Stapleton, 2012), a poorly maintained case increased the risk 6.4-fold and a rarely replaced case 5.4-fold. Fresh solution every evening, never topped up; case emptied, rinsed with solution, left to air-dry open, and replaced every three months. All the care mistakes are covered in detail in contact lens hygiene: common mistakes.

How long does it take to get used to them?

The technique is learned in a few days. At first, the eyelid closes by reflex, the lens flips over, the eye waters: this reflex soon fades if you do not force things. In routine practice, you stop noticing a soft lens within a few days; a rigid lens takes two to three weeks, with gradually increasing wear, a few more hours each day, because the eyelid feels its edge with every blink. If discomfort persists beyond these periods, it is the fitting itself that needs reviewing, not the technique; an eye that stays red, on the other hand, means removing the lens and seeing an ophthalmologist the same day or, failing that, going to the eye emergency department.

Signs that mean you should remove the lens and seek medical advice

Every contact lens wearer should know four signs: a red eye, pain (and not just discomfort), reduced vision and sensitivity to light. Each one means removing the lens and seeing an ophthalmologist the same day or, failing that, going to the eye emergency department, without putting the lens back in meanwhile. These signs may herald keratitis, that is, an inflammation or infection of the cornea, which responds better to treatment the earlier it is seen: at the Quinze-Vingts National Hospital Centre, contact lens wear was the leading factor found in a series of 300 cases of bacterial keratitis, in 50.3% of cases (Bourcier, 2003). Contact lens complications as a whole, most often benign, affect about one wearer in three according to the 2021 international CLEAR report (Stapleton). Bring the lens, the case and the bottle of solution to your appointment: they can be analysed. See also red eye: the causes and eye emergencies.

THE PRESCRIPTION

How to get contact lenses: prescription, fitting, renewal

A contact lens is a medical device: it is prescribed after an eye examination that checks the correction, the condition of the cornea and the quality of the tears, because marked dry eye can rule it out. Then comes the fitting: choice of lens type, base curve and diameter, a trial on the eye, then learning to put the lens in and take it out in front of the professional. At the Cachan practice, contact lens fittings are carried out by Dr Tourabaly’s associates; Dr Tourabaly sees patients in consultation in Cachan, in Paris 13 and at the Cabinet ophtalmologique Sorbonne Saint-Michel (Paris 5th).

A contact lens prescription is valid for a limited period, and renewing it involves a check-up, which confirms that the cornea tolerates lens wear and allows the type of lens to be adjusted, for example towards daily disposables, which need no cleaning and no case (see which lens to choose). If refractive surgery is being considered, you will need to stop wearing your lenses from a few days to a few weeks before the assessment, depending on their type (see stopping lenses before the assessment); the comparative cost of the two options is detailed in lenses or surgery: the cost over 10 years.

Frequently asked questions

Consultations in Cachan, Paris 13 and at the Sorbonne Saint-Michel practice (Paris 5th) · Tel. +33 1 45 47 08 11

Scientific sources

• Stapleton F, et al. CLEAR – Contact lens complications. Cont Lens Anterior Eye. 2021. PMID 33775382
• Arshad M, et al. Water exposure and the risk of contact lens-related disease. Cornea. 2019. PMID 30789440
• Stapleton F, et al. The incidence of contact lens-related microbial keratitis in Australia. Ophthalmology. 2008. PMID 18538404
• Dart JK, et al. Risk factors for microbial keratitis with contemporary contact lenses: a case-control study. Ophthalmology. 2008. PMID 18597850
• Stapleton F, et al. Risk factors for moderate and severe microbial keratitis in daily wear contact lens users. Ophthalmology. 2012. PMID 22521083
• Stapleton F, et al. Risk factors and causative organisms in microbial keratitis in daily disposable contact lens wear. PLoS One. 2017. PMID 28813424
• Carnt N, et al. Acanthamoeba keratitis: confirmation of the UK outbreak and a prospective case-control study identifying contributing risk factors. Br J Ophthalmol. 2018. PMID 30232172
• Bourcier T, et al. Bacterial keratitis: predisposing factors, clinical and microbiological review of 300 cases. Br J Ophthalmol. 2003. PMID 12812878
• Cope JR, et al. Contact lens wearer demographics and risk behaviors for contact lens-related eye infections — United States, 2014. MMWR Morb Mortal Wkly Rep. 2015. PMID 26292204
• Robertson DM, Cavanagh HD. Non-compliance with contact lens wear and care practices: a comparative analysis. Optom Vis Sci. 2011. PMID 21946785
• Dumbleton KA, et al. A multi-country assessment of compliance with daily disposable contact lens wear. Cont Lens Anterior Eye. 2013. PMID 23845663
• Ng A, et al. Impact of eye cosmetics on the eye, adnexa, and ocular surface. Eye Contact Lens. 2016. PMID 26398576

This article is intended for information only and does not replace a medical consultation. Indications, expected benefits and risks depend on each individual situation. For any question about your vision, consult an ophthalmologist.