Corneal Safety and Colored Contacts (2023)

In recent years, the colored contact lenses getting most of the attention have been the plano decorative lenses used for fashion or as a costume, obtained without the all-important involvement of an eye-care professional. These unregulated lenses are a serious public health concern, so much so that a cooperative spirit has emerged within the eye-care industry and it has been pressuring the federal government to act (See sidebar "Where 'Cosmetic' Lenses Currently Stand"). An explosive growth is occurring in this part of the contact lens market. Nearly 25 million patients who currently require vision correction are interested in colored contact lenses (Health Products Research Consumer Survey), as are 13 million non-vision corrected people (year 2000 Gallup poll). A July 2003 article in the Wall Street Journal tells us that global sales of corrective and noncorrective colored lenses climbed about 20 percent in 2002 to $350 million.

Non-Decorative Applications
As ophthalmologists, we must remember a colored contact lens has far wider applications than just changing a patient's eye color from brown to blue, or allowing him to decorate his eyes in support of his favorite football team during the playoffs. Using a colored contact lens or shell, we can offer comfort and cosmesis to patients with disfigured, misaligned and/or non-seeing eyes. Fitting opaque prosthetic lenses isn't going to generate revenue for most of us, but it does serve a physical and psychological need for our patients who are uncomfortable with the way their eyes look, or have an eye that's been damaged through trauma or disease.

Corneal Safety and Colored Contacts (1)
Remove surface deposits such as those seen in band keratopathy before placing a conjunctival flap and, later, a prosthetic colored contact lens or scleral shell.

The comprehensive ophthalmologist most often encounters a patient seeking a prosthetic contact lens to hide a disfigured eye, a scarred cornea or a malformed iris. An opaque colored lens might hide a strabismic eye that wasn't successfully treated in childhood. They can also be used to eliminate diplopia and acquired symptoms such as imbalance or photophobia, or disfigurement related to stroke, palsy, myopathy or trauma.

Masking disfigurement. The most common reason for a disfigured, blind eye is trauma. The demographic groups for ocular trauma are mostly children and young adults who have suffered fireworks injuries, motor vehicle accidents, industrial or work-related injuries and assaults. While we've been able to save the eye in many cases, the patient remains uncomfortable about his appearance and desires a prosthetic lens for a more natural look.

Hiding strabismus. Persons who are densely amblyopic and self-conscious about a crossed eye can be helped with an opaque colored lens. While hiding the eye is not appropriate treatment for a young child who might still require patching and strabismus surgery, it works for an adult in whom strabismus surgery isn't indicated and who wants his eyes to appear aligned.

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Other Conditions
Conditions such as albinism, aniridia and cone dystrophy usually leave a patient extremely photophobic. A dark, transparent tint will reduce photophobia for the albino patient, while in cases of aniridia an opaque lens can be used to recreate an iris and a colored lens can help reduce the amount of light admitted into the eye. In this situation, the use of a dark background tinted lens is best with a CIBA opaque ColorBlend pattern as an overlay. Other manufacturers of opaque lenses such as CooperVision and Vistakon have created iris patterns that closely resemble natural eye colors.

Where 'Cosmetic' Lenses Currently Stand
At the present time, decorative plano contact lenses are considered to be "cosmetics" by the U.S. Food and Drug Administration, and as such are subject to the labeling required by the FDA on all "dangerous" cosmetics. The ophthalmic community believes contact lenses must be treated seriously; they are not hairspray or eye makeup. They are medical devices that pose potential serious risks if not fit by an eye-care professional and properly maintained.

Pressure from physicians, professional groups, voluntary health organizations and American contact lens manufacturers has created an effort in Congress to amend the Food, Drug and Cosmetic Act to read that all contact lenses, regardless of intended use, should be considered medical devices. A version of this bill (HR 2218) passed in the House of Representatives (introduced by Representatives Henry Waxman (D-CA) and John Boozman (R-AR)) in November 2003, but legislation (S1747) sponsored by Senators Mike DeWine (R-Ohio) and Ted Kennedy (D-Mass) is currently held up in the U.S. Senate's Health, Education, Labor and Pensions Committee.

The dangerous consequences of unregulated lenses have touched me personally in my practice in Cleveland. In 2001, I treated a teenage girl whose vision was permanently damaged by lenses she wore solely to change her eye color from brown to green. She bought the lenses at a video store without a prescription. She wore them just once, but developed a Pseudomonas ulceration that caused so much damage that I had to perform a corneal transplant. This patient and others are described in a published series.5 Thankfully, I'm far from alone in my concern about unregulated and unmonitored decorative lenses and appreciate the multidisciplinary efforts of the eye-care community to get the word out on local, state and national levels. Out of the hands of professionals, these lenses pose a public-health risk and should be treated as such.

—Thomas L. Steinemann, MD, Cleveland

An occluder black opaque lens can allow the patient experiencing diplopia to have comfortable single vision. Lenses in "stock" colors should work well, but if a match with the other eye is required, most companies (CooperVision, Adventures in Color) will use a digital photo to match the fellow eye.

If a patient with keratoconus also has a need for cosmesis, you can use tinted lenses as the base in a piggyback system as described by optometrists Janice Jurkus and Jeffery Sonsino.1 They point out that "keratoconic patients wearing a piggyback system may experience less RGP movement if a dot-matrix opaque design is the soft lens base."

A piggyback lens system can also effectively mask corneal scarring. Emory University's Mike Ward and Buddy Russell describe a case2 in which a young woman presented with a full thickness corneal scar with partial aniridia and peripheral anterior synechiae in her left eye. She was fit with a combined rigid/soft piggyback lens system that provided visual acuity of 20/25. A FreshLook ColorBlends (CIBAVision) soft contact lens (median base curve, 14.5 mm diameter, plano, green) was used as the base lens and a rigid Fluorocon (CIBAVision) lens (BC = 8.20 mm, 10 mm diameter, power = +18 D) was placed on top.

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When selecting a lens for any of these applications, it's important to recognize your endpoint. If the eye has visual potential, select a lens or lens combination that will first optimize vision, then deal with glare, light sensitivity, etc., and then consider cosmesis. If the eye has no useful vision, the visual consequences of selection of an occluder lens may not be obvious to the patient and the best option may be a painted lens with a good fit.

Lens Selection
For the patient with minor disfigurement, a small budget or low motivation to wear a prosthetic lens, the practitioner may choose from a large selection of mass-produced colored lenses with or without refractive power. These may not offer the best color match or the optimal fit, but will satisfy certain patients. Others may be open to more expensive items such as custom-made lenses or scleral shells that are hand-painted and laminated. Standard enhancer tints won't impair vision and the pupillary area can be clear.

To mask serious trauma or a grossly misaligned eye, a hand-painted opaque custom-made lens may be the best choice to completely hide the natural eye and match the "good" one. However, these are expensive to order and to replace, if necessary. With such a wide selection of commercially available colored contact lenses on the market, especially in opaques, a prepackaged lens might just be a good option. This is especially true if the fellow eye is in need of vision correction, because then a matched pair of the lenses could be worn at the same time. For the patient who has visual capacity in the eye in question and needs vision correction, it is possible to take an existing clear corrective lens and send it out for tinting, for example, to help with photophobia or be made darker to mask a disfigurement. Digital photos of the fellow eye are important to guide the manufacturer.

While a discussion of lens types is beyond the scope of this article, I recommend referring to the June 2004 edition of Tyler's Quarterly. It's one of several contact lens industry publications offering a comprehensive listing of tinted daily-wear, extended-wear and opaque contact lenses.

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The Ocular Surface
Certainly, you have to first make a traumatized eye or an eye with an unstable ocular surface comfortable before you can fit any contact lens. Treat swollen, blistered ocular surfaces and remove deposits, such as band keratopathy. If dry eye is a problem, try punctal occlusion first as that will impact lens comfort. Aggressively treat lid disorders such as trichiasis, blepharitis, ectropion or entropion.

A conjunctival flap placed over the cornea provides a stable surface for the contact lens or prosthetic shell.3,4 Its purpose is twofold. The first goal is to eliminate ocular surface pain, keeping in mind that blind eyes may have internal or cyclitic pain that cannot be resolved with a conjunctival flap. The flap covers the cornea and prevents painful blisters or deposits from recurring. Some blind eyes, made so by either trauma or disease, develop calcium buildup. We can remove it, but there is a fairly high chance of it re-depositing. In cases of endothelial decompensation, bullous keratopathy too will eventually recur and cause pain. A superficial keratectomy and flap will smooth the surface, remove deposits and provide a stable barrier, eliminating the risk of recurrence under a cosmetic lens or scleral shell.

The second purpose of a conjunctival flap is to prepare the surface of the eye for wearing a prosthetic lens or shell. The surface it provides greatly reduces the chance of irritation of the eye by the lens, leading to vascularization or ulceration, as might happen if the surface were left irregular. The goal is to make sure the lens or the shell has the best fit possible.

Eye Health Considerations
Oxygen permeability. The lens specifications provided in Tyler's Quarterly reveal that the oxygen permeability of colored contact lenses is, in most cases, somewhat lower than that of corrective lenses and certainly lower than that of the new silicone hydrogels. CIBA's Night & Day lens, a silicone hydrogel, has a Dk of 140. Yet a colored lens by CIBAVision, the FreshLook ColorBlends, lists a Dk of 16.1.

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That's nearly a tenfold difference, which is worth noting for some patients with dry eye or ocular surface disease or compromised corneas. Gas exchange has been considered by other authors, including Michael Ward and Buddy Russell 2 who write that "the gas exchange through prosthetic lenses is often limited due to the qualities of necessary materials and manufacturing processes, including placement of opaque backing. This doesn't create a problem for clear corneas with good endothelial function or for heavily scarred and vascularized corneas where oxygen transmission is of limited concern."

Fit and movement. The fit of a colored contact lens on the eye should be the same as that of a comparable clear corrective lens. Of note, the range of available base curves of colored lenses may not be as large as that of their clear counterparts. A too-tight fit should be avoided at all costs because of potential hypoxia of the cornea, sometimes called tight-lens syndrome. But a lens that is too loose might move around to the extent that the opaque section obscures vision. On a non-seeing eye, however, this would be of little concern. Companies that provide tinting services only, such as Adventures in Color, can work from any lens fit and a digitized photo. Lenses with less than 45 percent water content are preferred.

Reduced visual field/peripheral vision. Since the clear pupil aperture may be smaller than the pupil size, patients may notice slightly fuzzy vision in the peripheral field. This may be more noticeable under mesopic conditions such as night driving or while at the movies.1 If the patient knows this ahead of time, the symptoms will not be as upsetting when they first appear.

Remember that an occluder lens will do a good job at what it's supposed to do—block vision—such as when one is fit to avoid double vision. Also, take into account that some tints, whether for sports or decoration, may interfere with contrast or change blue and green hues.

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As more people enter the colored contact lens market, we should understand the options available in both prosthetic and decorative lenses to best serve our patients. All of these new wearers are going to need proper fitting, education and follow-up. I'm concerned that, as we continue to release contact lens prescriptions as required by law, we will see an increase in damaged eyes. Patients who come to us asking for colored contact lenses, either plano or with power, give us an important opportunity to hammer home the point that unmonitored contact lens wear is a recipe for disaster.

Dr. Steinemann is a specialist in cornea and external disease in the Division of Ophthalmology at the MetroHealth Medical Center in Cleveland. He is also an associate professor of ophthalmology at Case Western Reserve University. Reach him at (216) 778-7144.

1. Jurkus J, Sonsino J. Beyond Blue and Green: The Many Applications of Tinted Contact Lenses. Contact Lens Spectrum. December 2001:24-29.
2. Ward M, Russell B. Prosthetic Lenses: Improving the Way We Look and See. Contact Lens Spectrum. December 2001:30-34.
3. Alino A et al. Conjunctival Flaps. Ophthalmology 1998;105:1120-1123.
4. Steinemann T. Alternative Management for Painful Blind Eyes. Unpublished case report.
5. Steinemann et al. Ocular Complications Associated with the Use of Cosmetic Contact Lenses from Unlicensed Vendors. Eye & Contact Lens 2003;29:4:196-200.

FAQs

How safe are coloured contact lenses? ›

Coloured contact lenses are totally safe to wear if you follow best practise when purchasing them and wearing them. If you are nervous or worried about getting them, visit your local optician or head to Superdrug Glasses Online for some advice.

How do you use colored contacts safely? ›

Top tips for taking care of your coloured contacts
  1. Wash and dry your hands before handling your lenses.
  2. Remove, clean and store monthly contact lenses at the end of each day. ...
  3. Never share your contacts with others.
  4. Insert your lenses before applying makeup.
4 Oct 2022

Do colored contacts make your vision blurry? ›

Be aware that coloured lenses can blur your sight if they are too thickly tinted. Evidently, opaque lenses increase the blurry effect, because they cover the entire pupil in a filter.

How long can you wear colored contacts? ›

Daily coloured contact lenses are disposable lenses that you must use only once after removing the lens from their liquid. Once applied to the eye, you can wear the lenses for about 8 hours but this may vary with brands, so ensure you check the packaging for manufacturer recommendations.

Can coloured lenses damage your eyes? ›

Just like with regular contact lenses, wearing colored contacts can increase the odds for eye and corneal infections, scratches on the cornea, possible allergic reactions, impaired vision, and even potential blindness. Colored contacts can slide around on the eye, which can impair vision.

Is it safe to wear coloured contact lenses everyday? ›

Coloured lenses are NOT bad for you, provided you buy a reputable brand like FreshLook. Such lenses come from the same manufacturers and are made from the same materials as normal everyday lenses, so from a health perspective they can be just as good as a non-coloured lens. 8.

What happens if you wear colored contacts too long? ›

Risks of wearing contacts too long

Corneal ulcers (infectious keratitis): An open sore in the outer layer of the cornea. Hypoxia: A lack of oxygen that can lead to abnormal blood vessel growth into the cornea. Damage to corneal stem cells needed to keep the cornea clear for good vision.

How long should I wear colored contacts for the first time? ›

For first-time colored contact wearers, Hamada says that it's best to start slow. "If you're a first-timer, it's best to wear them for less than five hours or what your eye doctor recommends," she explains.

How long can you wear colored contacts without taking them out? ›

How many hours per day can you safely wear contacts? Most people can safely and comfortably wear contact lenses for 14 to 16 hours per day. It's always best to try to remove them as soon as possible before you go to bed at night to give your eyes a chance to breathe without lenses in.

Why do my colored contacts move when I blink? ›

Does your contact lens feel like it's moving around in your eye? It may mean your lens does not fit your eye properly. If your lens is too loose on your eye, or if the diameter or base curve is not accurate, it can cause an increased awareness of your lenses, especially when you blink.

Why are colored contacts so uncomfortable? ›

While super rare, the cause of redness and discomfort from wearing coloured contact lenses might lie in the ingredients of the solution you use to clean them. All contact lenses are made of hypoallergenic materials, meaning that it's really unlikely for them to cause an allergic reaction.

Can you shower with colored contacts in? ›

Short answer is no, you shouldn't wear contacts in the shower. Contact lenses are like little plastic sponges that absorb what they come in contact with. The tap water in your home can contain microbes that you don't want in your eyes.

Can you wear 1 day colored contacts more than once? ›

Daily contact lenses that are disposable and single-use only should not be worn more than once after daily usage. Daily contacts that are old can scratch your eye and also cause more dangerous conditions to develop.

Can I wear colored contacts for 10 hours? ›

It can also increase your risk of bacterial or fungal infections, as well as ulcers, in the eye. TL;DR: Don't wear your contacts for longer than 12 hours without changing them or throwing them out!

Can wearing colored contacts change your natural eye color? ›

Colored contacts can completely change your eye color, but they can also correct your vision. Just the same as with clear contacts, color contacts can be fabricated to correct: Myopia (nearsightedness)

Why do people wear colored contacts? ›

Many people wear coloured contacts to change how they look on a daily basis. They might use the lenses to create a dramatic flair or even to match a certain outfit! No need to settle for the eye colour you were born with. A pair of contact lenses can change your eyes to almost any shade you like.

Why can you only wear contacts for 4 hours the first day? ›

Most contact lenses should not be worn overnight, as it could increase the risk of eye infection. Contacts meant for daily or one-time use can generally be worn up to 14 to 16 hours with no problem, but your doctor may recommend a contact-free hour or two before bedtime in order to rest your eyes.

How long should I rest my eyes from contacts? ›

Contact wearers should take the lenses out for a full day once a week. Many choose a day on the weekend when they are not out in public. Removing the contacts for a full day gives the eyes time to rest. It also allows extra oxygen to reach the eyes during those 24 hours.

What do I need to know before buying colored contacts? ›

What You Need to Know Before Getting Colored Contacts
  • Colored contacts are regular contacts that have been dyed. ...
  • Buying them online is a big no-no. ...
  • They're thicker than regular lenses. ...
  • Colored contacts can increase the risk of infection. ...
  • They need to be cared for the same way regular lenses do.
17 Nov 2015

How long does it take for your eyes to get used to colored contacts? ›

There Is an Adjustment Period

You should expect that it will take between 10 to 12 days for your eyes to adjust to your contacts. After all, your eyes are very sensitive.

Can you drive with Coloured contacts in? ›

Do not drive with Halloween contacts. Crazy contacts that cover your pupil cause vision impairment, so it's not advisable to drive while wearing them. Do not sleep while wearing coloured lenses.

Why are colored contacts illegal? ›

By law, decorative contact lenses, whether they correct vision or not, require a prescription and proper fitting from an eye doctor. Any type of contact lens that can be purchased without a prescription is being sold illegally—and can pose serious risks to sight and eye health.

Can you sleep with colored contacts in? ›

Is It Safe to Sleep With Contact Lenses In? It is not safe to sleep while wearing contact lenses. According to experts, sleeping with contacts increases your risk for a corneal infection, which is an infection of the clear layer protecting the colored part of your eye.

What happens if you dont take off your colored contacts? ›

When you leave your contacts in for an extended period of time, your eyeballs don't get the oxygen they need. That can lead to swelling of the cornea, which can lead to a corneal abrasion, and that's one way that bacteria can get in, causing infection.

What is legally blind in contacts? ›

If you wear contact lenses or eyeglasses, your eyesight will also be measured while wearing these corrective lenses. To be considered legally blind, your vision will need to be 20/200 or worse while wearing your lenses, or you must meet the visual field criteria.

What if lens goes behind eye? ›

For new contact lens wearers, a common worry is that a lens will become dislodged, and potentially move behind the eye and become stuck. Although it's possible for a contact lens to get stuck to the surface of your eye, the good news is that there's simply no way it can get lost, or trapped at the back.

Can I wash my face while wearing contact lenses? ›

The short answer is no. Water and contact lenses are incompatible, meaning they don't and shouldn't go together. This means washing your face, taking a shower, and swimming are all out of the question when you have contact lenses on. The main reason for this is most water is not sterile (germ-free).

Should contacts be blurry at first? ›

Some blurriness is common for new contact lens wearers. The distortion usually results from dryness. To counteract the moisture loss, talk to your eye care practitioner about medicated eye drops or pick up over-the-counter drops from your favourite drugstore. Do not drive or bike while experiencing blurry vision.

How do you know if your contacts are too strong? ›

When your prescription is too high, you will notice that you begin to feel dizzy and nauseous within some time of wearing your prescription glasses or lenses. This is a sure indication of a wrong prescription.

What happens if you wear contacts and glasses at the same time? ›

Yes. You can wear glasses and contact lenses at the same time. [toc]Many people do this because it fixes multiple issues they might have with their vision. The glasses might help with reading while the contacts improve farsightedness.

Why can't people with astigmatism have colored contacts? ›

Due to the irregular shape of the corneas, people who have astigmatism aren't able to use traditional spherical soft contact lenses to correct their vision - they must wear a specific type of lens, toric contact lenses for astigmatism, in order to correct their vision.

Do colored lenses affect mood? ›

Studies show that donning these shades can help users change their mood, depending on which color you pick: Green fosters relaxation, yellow enhances focus, red increases energy, and blue will make you feel refreshed.

Why are there no colored contacts for astigmatism? ›

Why the limitation? Sadly, the complexity of toric lenses makes it difficult and expensive to manufacture colored toric contacts. Prescriptions for astigmatism have many more correction combinations than non-toric prescriptions.

What to do if you accidentally shower with contacts? ›

If this happens, immediately close your eyes and carefully step out of the shower until you can remove the lenses correctly. If you notice any soreness or redness following the incident, get in touch with your optometrist as soon as possible.

Can I wear contacts in the pool? ›

Swimming with contacts can result in eye infections, irritation, and potential sight-threatening conditions such as a corneal ulcer. 2. The FDA has recommended that contacts not be exposed to ANY type of water, including tap water, swimming pools, oceans, lakes, hot tubs and showers.

How many days in a row can you wear one a day contacts? ›

You can only wear daily disposable contacts for one day and you cannot use them more than once. Without exception, you should throw them out after removing them, whether it's at the end of the day or after only a few hours.

What happens if you wear 1 day contacts for 2 days? ›

Wearing daily disposable contact lenses more than once puts you at risk for discomfort, dryness and serious eye infections. One study found contamination on the lenses of 95 percent of users who stored daily disposable lenses in saline overnight.

Can you take out daily contacts and put them back in same day? ›

Daily disposable contacts are designed to be thrown away after every single use, and people who reuse them risk painful and risky outcomes. Dailies are thinner, more fragile, and don't hold moisture as well as other contacts.

How long can you keep in colored contacts? ›

Daily coloured contact lenses are disposable lenses that you must use only once after removing the lens from their liquid. Once applied to the eye, you can wear the lenses for about 8 hours but this may vary with brands, so ensure you check the packaging for manufacturer recommendations.

Can I wear one day contacts for 3 days? ›

The short answer is no. You shouldn't wear daily disposable contacts more than once. However, you can safely re-wear daily extended-use lenses for up to a month (or however long your optometrist recommends).

Why Amazon doesn t sell colored contacts? ›

No matter whether you're looking for contact lenses that are purely cosmetic or those that are corrective, you can't buy them on Amazon. They're on the prohibited list because “they do not meet the checklist requirements”—though which requirements those are isn't clear.

Are colored contacts safe for 12 year olds? ›

In the end, there is no set age at which doctors recommend allowing children to wear colored contacts, it is a judgement call that you as parents must make together with your kids. When you're both ready, consult with your doctor to see what options are best for your child.

Can you wear coloured contacts in the shower? ›

Is it safe to wear contact lenses while showering or sleeping? No. It's absolutely not safe to wear contacts while immersed in water or when sleeping (unless you have contacts specifically intended for overnight wear).

At what age should you stop wearing contact lenses? ›

There is no maximum age limit to when you have to stop wearing contact lenses. You'll find, however, that your prescription requirements may change. There are certain age-related eye conditions such as presbyopia that will require you to wear multifocal contact lenses to be able to read and see.

At what age is it okay to wear colored contacts? ›

Contacts for kids are completely safe. Some special cases even require infants to wear them! But for general use, the recommended starting age is anywhere between 8-11 years old. Most start between 11 and 14.

Can a 7 year old wear contact lenses? ›

Since Dr. Fischer is a specialist in children, in some circumstances she prescribes contacts for very young children, even infants. However most children start wearing contact lenses at 8-12 years old. It is very important that children have glasses to rest their eyes from contacts every day.

What happens if you cry with contact lenses in? ›

Crying while wearing your contact lenses is completely safe for both you and your contact lenses, the tears won't damage the contact lenses -- they actually help to lubricate the lenses, allowing them to move more fluidly around on the corneas.

How long do you have to soak colored contacts? ›

Soaking Or Cleaning Your Lenses

You should always soak lenses in contact lens solution for at least two hours before insertion. Our coloured contacts should never be worn straight from the packaging. Coloured contacts are packaged in a saline fluid designed to keep them preserved and sterile in their packaging.

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