Corneal Ulcers and Contact Lenses: Why Sleeping in Them Is Risky
A corneal ulcer is an open sore on the cornea, the clear dome over the colored part of your eye. In contact lens wearers it's usually caused by an infection, and the biggest single risk is sleeping in your lenses. A red, painful eye in a contact lens wearer needs a same-day exam, because a corneal ulcer can scar the cornea and permanently blur vision if treatment is delayed.
If you wear contacts, you've probably dozed off in them at least once. Here's what a corneal ulcer is, why contact lenses and sleep make it more likely, and what to do if your eye starts to hurt.
What is a corneal ulcer?
The cornea is the eye's clear front window. A corneal ulcer happens when its surface breaks down and an infection gets into the tissue underneath. Doctors also call it infectious keratitis or microbial keratitis.
Bacteria cause most contact lens ulcers. Less often, fungi or an amoeba called Acanthamoeba are to blame. Acanthamoeba lives in tap water, pools, hot tubs and lakes, and it causes some of the hardest infections to treat.
A corneal ulcer is different from a corneal abrasion, which is a scratch. A scratch can turn into an ulcer, though, if germs get into it, and a contact lens can carry those germs right to the spot.
Why does sleeping in contact lenses cause corneal ulcers?
Your cornea gets most of its oxygen straight from the air. When your eyes are closed, that supply drops. A lens on top lowers it even more. With less oxygen, the surface of the cornea gets weaker and develops tiny breaks that germs can get through.
A lens worn overnight also traps germs against the eye for hours, with no blinking to wash them away. The CDC reports that sleeping in contact lenses raises the risk of a contact lens eye infection six- to eightfold.
A nap counts too. So does the occasional night when you're too tired to take them out. It only takes one night for an infection to start.
What else raises the risk?
- Swimming, showering or using a hot tub with lenses in
- Rinsing lenses or the case with tap water, or storing lenses in water
- "Topping off" old solution instead of using fresh solution every time
- Wearing lenses longer than they're meant to be worn, like stretching two-week lenses to a month
- Using an old or dirty lens case (replace it at least every three months)
- Handling lenses without washing and drying your hands
- Wearing lenses when your eye is already red or irritated
What are the symptoms of a corneal ulcer?
Symptoms usually start within a day and get worse quickly:
- Eye pain that keeps getting worse, often more than you'd expect
- Redness
- Strong sensitivity to light
- Tearing or discharge
- Blurry vision
- Feeling like something is in the eye
- A white or gray spot on the clear part of the eye, sometimes visible in the mirror
Many people think it's pink eye or an allergy. Our post on red eye causes explains the difference. In a contact lens wearer, pain plus redness should be treated as a possible ulcer until an eye doctor says otherwise.
What should I do if my eye hurts after wearing contacts?
Do:
- Take your lenses out right away and leave them out
- Put the lenses in their case and bring the lenses, the case and your solution to the visit
- Wear your glasses
- Call your eye doctor for a same-day visit
Don't:
- Put the lenses back in, even if the eye feels a little better
- Use old drops from another problem (especially steroid drops) or drops borrowed from someone else
- Use redness-relief drops to cover it up
- Wait a few days to see if it clears up
- Patch the eye
If you can't reach an eye doctor and your pain is severe or your vision is dropping, go to the emergency room.
How is a corneal ulcer treated?
We look at the cornea under the microscope with fluorescein, a dye that glows under blue light and outlines the ulcer. We measure its size and depth, check how inflamed the eye is, and look for signs of an unusual infection. For larger or more worrying ulcers, a sample may be taken to find the exact germ.
Treatment usually means strong antibiotic drops, often used every hour at first, even overnight. We see you again within a day or two to make sure it's improving. Ulcers that are large, near the center of your vision, or not responding are referred to a cornea specialist.
Most contact lens ulcers that are treated early heal well. An ulcer can leave a scar, though, and a scar in the center of the cornea can blur vision permanently. That's why the first 24 hours matter so much.
How can I prevent a corneal ulcer?
- Don't sleep in your lenses, including naps, unless your eye doctor prescribed them for overnight wear
- Keep water away from your lenses: no showering, swimming or hot tubs while wearing them, and no tap water on the lenses or case
- Rub and rinse lenses with fresh solution, and empty and air-dry the case every day
- Replace your case at least every three months
- Replace lenses on schedule. Daily disposable lenses are the simplest, because you start with a fresh pair every day
- Keep a backup pair of glasses so you're never tempted to wear lenses on a bad-eye day
- Come in for your yearly contact lens exam, so we can catch early warning signs on the cornea
What about DreamSculpt™ Ortho-K, which is worn overnight?
DreamSculpt Ortho-K lenses are designed and prescribed to be worn while you sleep. They're made of a rigid material that lets a lot of oxygen through, and we follow patients closely. Hygiene matters even more with them. Never let anything with tap water touch them, and keep every follow-up visit. Regular soft lenses are not made for overnight wear, even if they feel fine.
How we do it at Bolt Eye Group
At Bolt Eye Group, we offer same-day visits for red, painful or injured eyes at all five offices, on the days each office is open. If you wear contacts and your eye hurts, call us first. We examine the cornea under the microscope, start treatment the same day, follow you closely until it heals, and refer you to a cornea specialist if the ulcer needs one. We also help patients find safer lens options, like daily disposables, and fit specialty lenses when a regular lens won't work.
We accept VSP, EyeMed, Davis Vision, Spectera, Medicare and major medical plans, including Blue Cross Blue Shield, Aetna, UnitedHealthcare, Cigna and Humana. HSA/FSA and CareCredit are accepted.
Frequently asked questions
Is it OK to nap in my contact lenses?
No. Even a short nap lowers the oxygen reaching your cornea and keeps germs against the eye. If you fall asleep in them, take them out as soon as you wake up, wear your glasses for the rest of the day, and call us if your eye is red or painful.
My lenses say "extended wear." Can I sleep in them?
Only if your eye doctor prescribed them for overnight wear and is following you for it. Even approved overnight wear carries a higher infection risk than taking lenses out every night.
Can a corneal ulcer make you lose your vision?
It can if it isn't treated quickly. Most ulcers that are treated early heal well, but an ulcer in the center of the cornea can leave a scar that blurs vision. Severe cases can need a cornea transplant.
When can I wear contacts again after a corneal ulcer?
Only after your eye doctor confirms the ulcer has healed. Start with new lenses and a new case. Many patients switch to daily disposables afterward.
Can I use my antibiotic drops from last time?
No. Old drops may be the wrong medicine, may be contaminated, and steroid drops can make an infection much worse. Come in so we can see the eye and prescribe the right treatment.
Book an exam at your nearest Bolt Eye Group office
Red, painful eye and you wear contacts? Take your lenses out and call us for a same-day visit at your nearest Bolt Eye Group office in Canton, East Cobb/Marietta, Lawrenceville, Riverdale or Johnson City, TN. See all locations and directions.