Here's why you shouldn't sleep with contact lenses on

Michael Krumholz, a 21-year-old US man had a very troubling experience recently after he woke up from a nap. The man from Florida, who slept with contact lenses on his eyes, woke up after 40 minutes to find that he had difficulty in seeing through one eye. Diagnosed with Acanthamoeba Keratitis, a severe form of infection to the eye affecting the cornea, and thus resulting in loss of vision and pain in the eye, he is currently undergoing treatment and has already had two surgeries.

Life hasn't been easy for him after the experience because he can not only work but also cannot go outside, according to his GoFundMe page. Now, he wants to spread awareness about the infection and its effect especially among those who wear contact lenses. While doctors have told those wearing contact lenses over the years to never sleep with them, the latest experience is a reminder for every such person to understand why they need to take it seriously.

Mid-day Online spoke to Dr P Suresh, HOD - Ophthalmology, Fortis Hospital, Mulund and Dr Sujal S. Shah, director & consultant, Ophthalmology, Sir HN Reliance Foundation Hospital to understand more about the infection. The two experts also highlight how not all people who wear contact lenses get the infection but at the same time it is important to maintain contact lenses usage hygiene to take care of the eyes.

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What is Acanthamoeba keratitis and how is it caused?
Suresh: Acanthamoeba is a tiny, microscopic living organism that is found worldwide in many habitats. When it causes an infection of the front layer of the eye called the cornea, it is called Acanthamoeba Keratitis. It is caused by the entry of this parasite when there is microtrauma to the cornea. This infection is caused by a parasite that enters the cornea through small injuries, such as those caused by wearing contact lenses, exposure to contaminated water (e.g., swimming in dirty water), using homemade contact lens solutions, or injuring the cornea.

Shah: Acanthamoeba keratitis (AK) is an infection of the cornea with acanthamoeba, a parasite which is present in air, soil, dust and water.

Which age group is affected most by it?
Suresh: It can affect people across age groups. However, most patients are young to middle-aged adults, as a majority of this age group uses contact lenses and is also active in playing sports.

Shah: Approximately 85 per cent of AK is usually seen in contact lens users which is 15-45 years of age group and sometimes in non-contact lens users, usually elderly and is associated with trauma and exposure to contaminated water or soil, often in agricultural workers. The cornea comes in contact with bacteria every day, yet infection rarely happens. This is due to its natural defense mechanism in which the cornea needs to be well hydrated and well oxygenated.

What are the symptoms of a person suffering from Acanthamoeba keratitis?
Suresh: The symptoms include foreign body sensation, severe pain, redness, watering, decreased vision, and sensitivity to light.

Shah: AK patients most commonly complain of photophobia, pain, and tearing, usually in one eye, although disease may be bilateral in contact lens users. The pain in early AK may be severe, and disproportionate to the clinical signs, although some patients are pain free.

What are the effects of Acanthamoeba keratitis?
Suresh: Keratitis causes a reduction in vision initially, and when it heals it can leave a scar that can reduce the vision permanently. If untreated or delay in treatment, it can lead to Corneal Perforation and eventually loss of eyesight, and in rare cases loss of eyeball.

The man from Florida, who slept with contact lenses on his eyes, woke up after 40 minutes to find that he had difficulty in seeing through one eye. Photo Courtesy: Michael Krumholz/GoFundMe

What rules should people wearing contact lenses follow to avoid infection through it?
Shah: Follow these steps while using contact lens
1. Always wash and thoroughly dry your hands before handling contact lenses.
2. Carefully and regularly clean contact lenses even when not used daily.
3. Store lenses in the proper lens storage case and replace the case at least every three months.
4. Use only fresh solutions to clean and store contact lenses.
5. Remove contact lenses before swimming or entering a hot tub.
6. Avoid tap water to wash or store contact lenses or lens cases
7. Don't share lenses, especially cosmetic contact lenses as it spreads germs and bacteria.
8. Don't sleep with contact lenses.

Does wearing contact lenses cause the infection?
Suresh: Wearing contact lenses is very safe, if the medical advice is followed. Using homemade contact lens solution and not following instructions for contact lens care can increase the risk of corneal infections, including Acanthamoeba Keratitis.

Shah: While you're awake, blinking keeps your eyes moist, and oxygen can flow in through the tears you produce. Contacts fit over the surface of your eye, significantly cutting the amount of oxygen and moisture your eyes can access thus predisposing the eyes to infection. Not all who wear contact lenses develop eye infection.

Can people wear contact lenses and go to sleep? What are the dangers of doing it?
Suresh: People should not go to sleep with contact lenses in their eyes. The risk of corneal infection increases multifold with this practice.

What rules should people wearing contact lenses follow to avoid infection through it?
Suresh: The contact lens should be replaced as per schedule. Daily disposable lenses have maximum safety against infection and should be considered strongly. One should not over wear the lens, and ideally, eight hours of wear should be safe. Never sleep with the lens in your eyes. Cleaning of the lens should be followed with a commercially available cleaning solution. For any pain or redness, the lens should not be worn and medical advice to be sought.

How can Acanthamoeba keratitis be prevented?
Suresh: It can be prevented by following steps:

1. Don't over wear or sleep with contact lens.
2. Don't wash the eye with dirty water.
3. Don't swim in unregulated places.
4. For any eye injury, visit a nearby eye doctor and seek treatment.

Can the infection of Acanthamoeba Keratitis be treated?
Suresh: Of course, it can be treated with a specific set of antibiotic eye drops. In advanced stages, a corneal transplant may be the only option available.

Shah: Acanthamoeba infection can be treated medically but the treatment can extend up to as long as 6-9 months and in very severe cases even corneal transplant surgery may be required. Key to recovery is early diagnosis and initiation of treatment within three weeks of disease. As we know, there is an old saying, prevention is better than cure key points while using contact lenses.

What are the steps to follow to maintain good eye hygiene?
Suresh: To maintain good eye hygiene one should eat an adequate amount of green and coloured vegetables and fruits. Protect your eyes whenever there is potential for eye injury, for example, safety glasses. During festival time beware of injury from firecrackers, water balloons, liquid colours and powder colours. Limit the use of contact lens wear. It is recommended to have an annual eye checkup with a doctor after the age of 40, or earlier if there is a family history of eye disease.

Shah: Poor contact lens hygiene, including swimming or showering while wearing your contact lenses, increases your risk. One shouldn't sleep overnight with lenses as it decreases the amount of oxygen reaching your cornea and thus makes your eye more susceptible to infection.

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