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Impact of Lens Case Hygiene Guidelines on Contact Lens Case Contamination

Wu, Yvonne T.*; Teng, Yuu Juan*; Nicholas, Mary*; Harmis, Najat†; Zhu, Hua‡; Willcox, Mark D. P.‡; Stapleton, Fiona§

doi: 10.1097/OPX.0b013e3182282f28
Original Article

Purpose. Lens case contamination is a risk factor for microbial keratitis. The effectiveness of manufacturers' lens case cleaning guidelines in limiting microbial contamination has not been evaluated in vivo. This study compared the effectiveness of manufacturers' guidelines and an alternative cleaning regimen.

Methods. A randomized cross-over clinical trial with two phases (n = 40) was performed. Participants used the lens types of their choice in conjunction with the provided multipurpose solution (containing polyhexamethylene biguanide) for daily wear. In the manufacturers' guideline phase, cases were rinsed with multipurpose solution and air dried. In the alternative regimen phase, cases were rubbed, rinsed with solution, tissue wiped, and air-dried face down. The duration of each phase was 1 month. Lens cases were collected at the end of each phase for microbiological investigation. The levels of microbial contamination were compared, and compliance to both regimens was assessed.

Results. The case contamination rate was 82% (32/39) in the manufacturers' guideline group, compared with 72% (28/39) in the alternative regimen group. There were significantly fewer (p = 0.004) colony forming units (CFU) of bacteria from cases used by following the alternative regimen (CFU range of 0 to 104, and median of 12 CFU per well) compared with that of the manufacturer's guidelines (CFU range of 0 to 105, and median of 28 CFU per well). The compliance level between both guidelines was not significantly different (p > 0.05).

Conclusions. The alternative guidelines are more effective in eliminating microbial contamination from lens cases than that of the current manufacturer's guideline. Simply incorporating rubbing and tissue-wiping steps in daily case hygiene reduces viable organism contamination.





School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia and Brien Holden Vision Institute (YTW, NH, HZ, MDPW, FS), Sydney, New South Wales, Australia.

Received April 3, 2011; accepted May 20, 2011.

Yvonne Wu; Brien Holden Vision institute; Level 4, North Wing Rupert Myers Building Gate 14, Barker St; University of New South Wales; Sydney, 2052 New South Wales; Australia; e-mail:

© 2011 American Academy of Optometry