Why this guide matters
Contact lens intolerance is one of the most common reasons patients begin exploring long-term vision correction options. Understanding the causes, risks, and alternatives helps you make informed decisions about your eye health.
INDEX
- Understanding Contact Lens Intolerance
- Why Vision Correction Is So Important
- Why Do Contact Lenses Become Intolerable?
- How to Treat Contact Lens Intolerance
- When Conservative Treatment Is Not Enough
- Clinical Perspective
- The Safety Comparison: Contact Lenses vs LASIK
- Contact Lens Microbial Keratitis Risk Explained
- What About Dry Eye?: Contact Lenses vs LASIK
Understanding Contact Lens Intolerance
If your contact lenses are no longer as comfortable as they once were, you are not imagining it. Contact Lens Intolerance, also referred to as Contact Lens Discomfort (CLD), occurs when the eye can no longer comfortably tolerate contact lenses.
Early signs you may notice:
- Burning at the end of the day
- Needing eye drops more often
- Shorter wearing time
- Redness after removal
Ongoing symptoms to be aware of:
- Dryness
- Gritty or foreign body sensation
- Blurred or fluctuating vision
- Increased light sensitivity
- Reduced wearing time
- Recurring irritation or infection
Contact lenses rely on a stable tear film. When tear quality declines, tolerance decreases.
For many patients, this is the turning point where they begin to explore alternatives such as LASIK, PRK or implantable contact lenses. This guide by Sandton Eye Clinic in Johannesburg provides a research-based, balanced comparison of all vision correction options so that you can make an informed decision about your long-term eye health.
- How Common Is Contact Lens Discomfort?
Research shows:
- 21% discontinue contact lens wear due to discomfort
Why Vision Correction Is So Important
Globally, uncorrected refractive errors account for approximately 53% of visual impairment, making them the leading cause worldwide.
Refractive errors include:
Myopia
(short-sightedness)
Hyperopia
(long-sightedness)
Astigmatism
(blurred vision)
Presbyopia
(aging eyes)
Glasses, contact lenses, laser vision correction like LASIK and implantable contact lenses are all effective methods of correcting these conditions. The difference lies in how they interact with your eyes over time. Glasses are the safest as there is no surgical intervention involved. For those who require freedom from glasses in their daily life, contact lenses are the next logical step.
Contact lenses are often incorrectly considered the safest alternative. However research shows that laser and surgical vision correction may be safer and result in higher satisfaction. In this article we will look at all the alternatives to glasses and research based information about each. We will start with contact lenses and how to prevent or treat contact lens intolerance and then move on to laser and surgical alternatives to glasses.
Why Do Contact Lenses Become Intolerable?
Several mechanisms contribute to contact lens intolerance:
1. Tear Film Disruption
Contact lenses sit directly on the cornea and alter tear film dynamics.
2. Oxygen Reduction
Even modern lenses reduce oxygen transmission compared to natural exposure.
3. Chronic Micro-Trauma
Daily insertion and removal may cause microscopic epithelial disruption.
4. Increased Infection Exposure
Each insertion introduces potential microbial contamination.
5. Environmental Stress
Low humidity, air travel, air conditioning and digital device use worsen dryness
Over time, these factors accumulate.
Key Data on Dropout Rates & Timing
- Within 6 Months: Approximately 27% of eventual dropouts occur within the first six months.
- Within 1 Year: About 65% of all contact lens dropouts happen during the first year of wear.
- By 2 Years: Studies indicate that 12% to 27.4% of wearers permanently drop out within two years.
How to Treat Contact Lens Intolerance (If You Want to Continue Wearing Contacts)
Not every patient with contact lens intolerance needs to stop wearing lenses immediately. In many cases, symptoms can be improved with appropriate management — especially when identified early.
The key is to address the underlying cause rather than simply increasing artificial tear use.
Step 1 | Evaluate for Dry Eye Disease
Dry eye is one of the most common contributors to contact lens discomfort.
Research published in the Journal of Cataract & Refractive Surgery (2022) highlights the importance of actively diagnosing and treating dry eye disease before considering refractive procedures — but the same principle applies to contact lens wear.
Management may include:
- Preservative-free lubricating drops
- Lipid-based tear supplements for evaporative dry eye
- Warm compresses for meibomian gland dysfunction
- Omega-3 supplementation (where appropriate)
- Prescription anti-inflammatory therapy when indicated
Stabilising the tear film can significantly improve lens tolerance.
Step 2 | Reassess Lens Type and Material
Not all contact lenses are the same.
Patients struggling with intolerance may benefit from:
- Switching to daily disposable lenses
- Trying higher oxygen-permeable silicone hydrogel materials
- Reducing wearing time
- Avoiding extended-wear or overnight lenses
Studies show that extended wear significantly increases infection risk.
Daily disposables reduce solution-related sensitivity and microbial contamination exposure.
Step 3 | Improve Lens Hygiene
Even mild hygiene lapses can contribute to chronic irritation.
Best practice includes:
- Washing and drying hands before insertion
- Using fresh solution daily
- Avoiding tap water exposure
- Replacing lens cases every 1–3 months
- Strictly avoiding sleeping in lenses unless medically prescribed
For many patients, improved hygiene alone reduces inflammation.
Step 4 | Address Environmental and Lifestyle Factors
Contact lens intolerance is often worse in:
- Air-conditioned environments
- Aeroplane cabins
- Prolonged screen use
- Low-humidity climates
Practical measures include:
- Taking regular blinking breaks
- Using humidifiers
- Limiting wear during air travel
- Removing lenses earlier in the day
Step 5 | Consider Specialty Lens Fitting
For patients with:
- Irregular corneas
- High prescriptions
- Ocular surface disease
Specialty options such as scleral lenses may improve comfort by vaulting the cornea and maintaining a fluid reservoir. These are available at certain specialist optometrist centres and well as Sandton Eye Clinic.
When Conservative Treatment Is Not Enough
If symptoms persist despite:
- Dry eye treatment
- Material changes
- Hygiene optimisation
- Reduced wear time
Then it may be appropriate to explore longer-term solutions such as:
- Laser Vision Correction Like LASIK and PRK
- Implantable Contact Lenses
- Presbyopia Correction like PresbyLASIK, Allotex
The goal is not to stop contact lenses prematurely.
The goal is to protect long-term corneal health.
Clinical Perspective
Contact lens intolerance is often progressive.
Patients frequently notice:
- Gradually shortening wear time
- Increasing dependence on lubricants
- Recurring redness
- Reduced comfort tolerance year after year
When this pattern continues despite proper management, it suggests the ocular surface may no longer tolerate chronic lens wear. If contact lenses are not comfortable and you struggle with repeated infections it is not wise to continue contact lens wear. Strongly consider wearing glasses again. If this does not suit your lifestyle consider laser and surgical options.
At that stage, a refractive consultation at Sandton Eye Clinic may allow you to explore all options safely and objectively.
The Safety Comparison:
Contact Lenses vs LASIK
Both options are considered safe when properly managed.
However, the structure of risk differs significantly.
Daily Cumulative Risk vs One-Time Procedural Risk
A 2017 study in the Journal of Cataract & Refractive Surgery found:
- Higher rates of microbial keratitis in contact lens wearers
- Significantly increased risk with extended or overnight wear
- Lower long-term infection risk following LASIK
Contact lenses carry a daily cumulative risk.
LASIK carries a short-term procedural risk.
The distinction is important.
A contact lens wearer may insert and remove lenses thousands of times over 20 years. Each episode carries small but real exposure risk.
The risks associated with LASIK are predominantly confined to the surgical procedure, conducted in a controlled, sterile laser theatre.
Masters et al (2017). Risk for microbial keratitis: Comparative metaanalysis of contact lens wearers and post-laser in situ keratomileusis patients. Journal of cataract and refractive surgery, 43(1), 67–73.
Our Vision Correction Options by Age
Contact Lens Microbial Keratitis Risk Explained
Microbial keratitis is one of the most serious complications associated with contact lens wear.
Although uncommon, it can threaten vision if not treated promptly.
Understanding the mechanism, prevalence, microbial causes, and long-term risks helps patients make informed decisions about safe lens use.
What Is Microbial Keratitis?
Microbial keratitis is an infection of the cornea caused by bacteria, fungi, parasites, or viruses.
The cornea is normally protected by:
- An intact epithelial surface
- A stable tear film
- Antimicrobial proteins in tears
- Blinking and mechanical clearance
Contact lenses can compromise these protective mechanisms by:
- Causing micro-abrasions to the epithelium
- Reducing oxygen transmission
- Trapping bacteria against the corneal surface
- Altering the tear film
- Acting as a surface for biofilm formation
When the epithelial barrier is disrupted, microbes can invade the cornea.
How Common Is Contact Lens–Related Keratitis?
The risk varies by lens type and wear pattern.
Annual Incidence Estimates
Daily disposable Contact lens wearers:
Approximately 2-4 cases per 10,000 wearers per year
Extended wear (overnight) lenses:
Approximately 10–20 cases per 10,000 wearers per year
These figures come from large epidemiological study: The incidence of contact lens–related microbial keratitis in Australia. Ophthalmology 2008. .
Loss of vision occurred in 0.6 per 10,000 wearers. Sleeping in lenses remains the strongest independent risk factor. Other risk factors included poor storage case hygiene, smoking, internet purchase of contact lenses, <6 months wear experience, and higher socioeconomic class.
Why Swimming With Contact Lenses Is Risky
Water contains microorganisms — including:
- Swimming pools
- Hot tubs
- Lakes
- Showers
Contact lenses can:
- Trap contaminated water against the cornea
- Create a microenvironment favourable for microbial growth
- Reduce oxygen, weakening corneal defences
The CDC explicitly advises against swimming in contact lenses.
Even chlorinated pool water does not eliminate Acanthamoeba risk.
Long-Term Damage Risks From Microbial Keratitis
If diagnosed early, many infections resolve with antibiotic therapy.
However, delayed treatment can lead to:
- Corneal scarring
- Permanent irregular astigmatism
- Reduced visual acuity
- Need for corneal transplantation
- In severe cases, vision loss
Studies show that microbial keratitis can result in permanent vision reduction in a significant subset of cases.
In some cases, patients require:
- Intensive fortified antibiotics
- Hospital admission
- Corneal graft surgery
Risk Factors That Increase Infection Likelihood
The strongest risk factors identified in epidemiological studies include:
- Overnight lens wear
- Poor hand hygiene
- Infrequent case replacement
- Exposure to water
- Smoking
- Extended lens replacement schedules
- Purchasing lenses without professional fitting
How Does This Compare to LASIK?
A 2017 comparative study in the Journal of Cataract & Refractive Surgery examined long-term infection risk and found:
- Contact lens wearers had higher cumulative risk of microbial keratitis
- LASIK patients had lower long-term infection incidence
The key distinction:
Contact lenses introduce repeated exposure risk over decades.
LASIK carries a short controlled procedural risk period.
Balanced Perspective
It is important to emphasise:
- The absolute risk of infection remains low
- Millions of people safely wear contact lenses daily
- Good hygiene significantly reduces risk
However, microbial keratitis remains one of the most serious potential complications of contact lens wear. For patients developing recurrent inflammation or contact lens intolerance, understanding these risks helps frame whether continuing long-term wear remains appropriate.
Reference: CDC Contact Lens Safety Guidelines.
What About Dry Eye?:
Contact Lenses vs LASIK
Dryness is one of the most common reasons patients stop wearing lenses.
LASIK can also temporarily worsen dry eye.
However, the PROWL studies published in JAMA Ophthalmology showed:
- Over 95% patient satisfaction following LASIK
- Postoperative symptoms such as dryness were generally transient
- Previous contact lens wearers reported less dry eye symptoms one year after LASIK than those who continued contact lens wear
Modern refractive practice emphasises preoperative ocular surface optimisation, as highlighted in the Journal of Cataract and Refractive Surgery (2022). At a specialist practice, treating dry eye before surgery significantly improves outcomes.
Source: TFOS Contact Lens Discomfort Workshop.
This content is for educational purposes. If you experience ongoing discomfort, a professional eye assessment is recommended.
Dry Eye, Digital Strain and Contact Lenses
Digital screen use can worsen dryness in contact lens wearers. When working on a computer or mobile device, people tend to blink up to 60% less frequently, which reduces the spread of tears across the eye surface. This allows the tear film to evaporate more quickly, leading to dryness, irritation, and fluctuating vision during contact lens wear.
To help prevent dryness while working on a computer:
- Follow the 20–20–20 rule: every 20 minutes, look at something 20 feet away for 20 seconds.
- Make a conscious effort to blink fully and regularly.
- Use preservative-free lubricating eye drops if needed.
- Position your screen slightly below eye level, which helps reduce tear evaporation.
- Take short breaks and limit continuous screen time where possible.
Reference: Rosenfield M. Computer vision syndrome (digital eye strain).
This information is for educational purposes. Individual experiences may vary, and suitability for vision correction should be assessed during a consultation.
A Balanced Comparison of All Vision Correction Options
There is no universal solution. The correct option depends on your eyes and your lifestyle.
1. Glasses
Glasses are the safest option because there is no medical procedure involved.
Advantages:
- No corneal contact
- No surgical intervention
- Immediate reversibility
- Readers bifocal, trifocal and multifocal options for presbyopia
Limitations:
- Peripheral distortion in high prescriptions
- Fogging
- May be less practical for certain activities such as swimming, water sports, or high-movement environments or contact sports.
- Can be dislodged or lost during activities like running, hiking, or adventure sports
- Multifocal lens adaptation challenges and higher fall risk in the elderly
Glasses remain an excellent option for patients who are comfortable wearing them, although lifestyle and activity level may influence what feels most practical for daily use.
2. Contact Lenses
Contact lenses offer natural peripheral vision and freedom from frames.
Advantages:
- Wide visual field
- Better performance in certain sports
- Cosmetic preference
- Presbyopia correction options
Limitations:
- Daily maintenance
- Ongoing cost
- Infection risk
- High prevalence of dryness
- Contact lens intolerance
- Long term dropout rates up to 36%
- Adaption challenges with multifocal contacts with 25% early dropout rate
They require a healthy ocular surface to remain successful long term.
LASIK reshapes the cornea using advanced laser technology.
Advantages:
- One-time procedure
- Rapid recovery
- High satisfaction rates (>95%)
- Lower long-term infection risk than contact lenses
Considerations:
- Not suitable for all corneas
- Requires stable prescription
- Temporary dry eye possible (less than with contact lenses)
Modern LASIK uses femtosecond technology and customised treatment algorithms to improve precision and reduce side effects.
PRK reshapes the surface of the cornea using advanced laser technology.
Advantages:
- One-time procedure
- Suitable for patients with thinner corneas or certain surface considerations.
- Safe for those who enjoy contact sports
- Superficial scars or irregularities can be treated
Considerations:
- recovery is slower than LASIK
Long-term visual outcomes are comparable to LASIK.
Unlike external lenses, implantable lenses are placed inside the eye.
Advantages:
- No corneal tissue removal
- Excellent optical quality
- Suitable for high prescriptions
- Reversible
- Rapid recovery
Considerations:
- Cost of lenses may be higher than Laser Vision Correction
For patients with contact lens intolerance due to surface dryness, this may be an effective alternative because it does not depend on tear film stability.
Who Is a Candidate for Surgical Vision Correction?
Approximately 95% of patients aged 18–55 qualify for LASIK, PRK or implantable lenses. A small percentage may not qualify due to underlying eye disease
At Sandton Eye Clinic, suitability is determined only after comprehensive testing, including:
- Corneal topography and tomography
- Tear film evaluation
- Ocular surface health screening
- Screening for other eye diseases
- Lifestyle and occupation visual need evaluation
- Contact lens trail if deemed necessary
Safety and patient selection remain the highest priorities.
When Should You Consider a Consultation?
As a contact lens wearer, you may benefit from specialist evaluation if:
- Your contact lens wear time is decreasing (You can no longer wear contact lenses comfortably for extended periods)
- You rely increasingly on artificial tears
- You have experienced recurrent inflammation
- You are concerned about long-term lens wear
- You value freedom from daily maintenance
Key Takeaways
- Contact lenses are safe but carry cumulative daily risk.
- LASIK carries a short-term procedural risk but lower long-term infection exposure.
- Up to 50% of lens wearers experience discomfort.
- Satisfaction rates are significantly higher after LASIK than continued contact lens wear.
- Proper screening and dry eye management are critical for optimal outcomes.
Explore Your Options
If you are experiencing contact lens intolerance, the next step is not necessarily surgery.
The next step is information.
You can:
At Sandton Eye Clinic, our focus is not on performing procedures.
It is on recommending the safest, most appropriate solution for your eyes and lifestyle.
Our Vision Correction Options by Age
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FAQ’s About Contact Lenses
Can a contact lens get lost behind my eye?
No. A contact lens cannot travel behind the eye. The conjunctiva prevents this. However, it may move under the upper eyelid and cause discomfort. If it cannot be removed easily, an eye care professional should examine the eye.
What do I do if I can’t remove my contact lens?
If a lens feels stuck, use lubricating eye drops (specifically for contacts) and gently massage the eyelid before trying to pinch it out. Be careful not to scratch your cornea.
How long can I wear contact lenses each day?
- Daily Disposables: Typically worn for 10-12 hours, then discarded.
- Monthly/Reusable Lenses: Generally removed, cleaned, and stored nightly to avoid eye irritation.
- Extended Wear: Only use lenses specifically designed for sleeping, as standard lenses reduce oxygen to the eye, increasing infection risk.
- Listen to Your Eyes: Avoid pushing beyond the point of comfort to avoid dryness, redness, and discomfort
Always consult your optometrist for a personalized wearing schedule.
Why do my contact lenses suddenly feel uncomfortable?
- Tear film instability
- Dry eye disease
- Lens material intolerance
- Reduced oxygen transmission
- Environmental dryness
- Extended wear
What happens if I sleep in my contact lenses?
Sleeping in contact lenses significantly increases the risk of infection. Studies show higher microbial keratitis risk among extended-wear users
Even lenses marketed as “night and day” carry increased risk when worn overnight.
Are cheap or cosmetic coloured contact lenses safe?
Unregulated lenses may:
- Reduce oxygen transmission
- Increase bacterial adhesion
- Cause corneal abrasions
Always purchase lenses through a registered practitioner to ensure proper fit and safety
Do I need a prescription for coloured contact lenses if I don’t need vision correction?
Yes, coloured contacts are medical devices and require a prescription from an eye care professional to ensure proper fit and safety.
Is LASIK safer than contact lenses?
Both are considered safe when appropriately managed.
However:
- Contact lenses carry daily cumulative risk
- LASIK carries a short-term procedural risk
- Long-term infection risk is lower in LASIK patients compared to contact lens wearers
If I have contact lens intolerance, can I still qualify for LASIK?
Possibly. Many patients with contact lens intolerance are good candidates for LASIK, PRK or implantable contact lenses, provided their corneas are healthy and prescriptions stable.
A comprehensive evaluation is required.
Can dry eyes from contact lenses become permanent?
While contact lens-induced dry eye is usually temporary and reversible by stopping lens wear,
it can lead to chronic or long-term dry eye syndrome if the surface of the eye is damaged by prolonged, untreated irritation. Long-term, improper use of lenses can create persistent discomfort requiring medical intervention, rather than just temporary relief.
Can I use tap water to clean my lenses?
Never use tap water. Only use the cleaning solution prescribed by your optometrist. Using tap water can lead to serious eye infections.
What should I do if I drop a lens?
Clean and disinfect it thoroughly before putting it back in your eye.
Can I wear makeup with contacts?
Yes, you can wear makeup with contact lenses, but you must follow specific safety practices to avoid irritation or damage to your lenses. Always insert lenses before applying makeup and remove them before taking makeup off. Use oil-free, non-powder products, wash brushes often, and avoid applying eyeliner to the inner eyelid.
What if I leave my contact lenses in too long by mistake?
Leaving contact lenses in too long can cause dry, stuck lenses, discomfort, or potential eye infections. If stuck, lubricate with eye drops, blink frequently, and do not force them out. Remove them gently and allow your eyes to rest without lenses the next day. Seek eye care immediately if you have persistent pain, redness, or vision changes.
Can children wear contact lenses?
Yes, children as young as eight can wear them if they demonstrate maturity and responsibility for care.
Can I be too old for contacts?
There is no strict age limit. Multifocal lenses are common for older adults. Drop out rates are higher for multifocal lenses than for monofocal lenses. The risk for dry eyes and contact lens intolerance increases as you age.
Are contact lens and eyeglasses prescriptions the same?
No. Contact lenses sit directly on the eye, while glasses sit at a distance, requiring different measurements.
Why do contact lenses become uncomfortable over time?
Contact lenses become uncomfortable over time primarily due to dry eye, protein/debris buildup, reduced oxygen flow, and improper fit. Factors like over-wearing, sleeping in lenses, and sensitivity to cleaning solutions can cause irritation and inflammation.
Are daily disposable contact lenses better for dry eyes?
Yes, daily disposable contact lenses are generally considered better for dry eyes compared to monthly or bi-weekly options. By providing a fresh pair each day, they eliminate the buildup of proteins, lipids, and allergens that cause irritation, while often offering better moisture retention and higher oxygen permeability, leading to increased comfort
Can I switch back to glasses after contact lens intolerance?
Yes, you can absolutely switch back to glasses after experiencing contact lens intolerance. This approach allows your eyes to heal, and you can always consider long-term alternatives like LASIK or new contact lens materials after your eyes healed.
Is contact lens intolerance reversible?
Yes, contact lens intolerance (CLI) is generally reversible for most patients, as it is rarely a permanent condition. Reversing it often involves addressing the root cause, such as dry eye, poor lens fit, or allergies, by switching to daily disposables, using lubricating drops, or taking a break from wearing lenses.
Do contact lenses reduce oxygen to the eye?
Yes, contact lenses reduce the amount of oxygen that reaches the cornea, acting as a barrier between the eye and the atmosphere. While modern, highly breathable lenses (like silicone hydrogels) allow significant oxygen flow, traditional lenses can cause hypoxia (oxygen deprivation), resulting in dryness, irritation, swelling, and potential long-term damage.
Is it safe to buy contact lenses online?
Buying contact lenses online can be safe if you have a valid prescription and use a reputable supplier. However, contact lenses should ideally be fitted and supplied by an optometrist, who can ensure the correct fit and monitor for early signs of dryness or intolerance.
If purchasing online, make sure the lenses match your prescription exactly and come from a trusted source. Avoid unverified sellers, as poor-quality lenses may increase the risk of discomfort or infection.
What are the early signs of an eye infection from contact lenses?
Early signs of a contact lens-related eye infection include persistent redness, pain or discomfort, sensitivity to light, and blurred vision. Other symptoms include excessive watering, discharge, a sensation that something is stuck in the eye, and increased lens awareness. Remove lenses immediately and consult an eye doctor if these occur.
Can I swim with contact lenses?
Never swim with contact lenses because it significantly increases the risk of irritation, severe eye infections, corneal ulcers, and even blindness. Water from pools, hot tubs, lakes, and the ocean can trap bacteria or parasites behind the lens. If necessary to see clearly when swimming, use prescription goggles or consider laser vision correction.
What is the safest vision correction option?
There is no single “safest” option for everyone. The most appropriate choice depends on your eyes, lifestyle, and preferences.
• Glasses: A safe, non-procedural option for those comfortable with daily wear
• Contact lenses: Safe when properly fitted and maintained, provided they remain comfortable and hygiene is followed
• LASIK: A well-established option for those seeking unaided vision.
• PRK: Suitable for patients with active lifestyles, contact sports, or thin corneas.
• Implantable contact lenses: An option for higher prescriptions or when laser vision correction is not suitable
A comprehensive assessment with an eye care professional is the best way to determine which option is most appropriate for your individual needs.
Why should I remove my contact lenses before a refractive procedure?
Contact lenses can temporarily change the shape of the cornea. Removing contact lenses allows the cornea and tear film to stabilise before treatment. Your surgeon will advise on the most appropriate lens-free period for you, as individual timelines may vary.
Can I still wear coloured contact-lenses after a vision correction procedure?
Yes you can. Ensure that any contact lens wear is prescribed and monitored by a healthcare professional. Only order lenses from a reliable source. Keratopigmentation may also be an option to change the colour of your eyes. Keratopigmentation, also called corneal tattooing, is a specialized procedure that alters or restores eye colour by injecting biocompatible pigments into the middle layer of the cornea. It can be done for medical reasons (like correcting scars or reducing glare) or purely for cosmetic eye colour changes.