2.12 Removal of Dislocated Contact Lens
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agk's Library of Common Simple Emergencies

Presentation
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The patient may know the lens has dislocated 
into one of the recesses of the conjunctiva, 
and complain only of the loss of refractory 
correction; or he may have lost track of the 
lens completely, in which case the eye is a 
logical place to look first. Pain and blepharo- 
spasm suggest a corneal abrasion, perhaps from 
removal attempts.

What to do:
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- If pain and blepharospasm are a problem, 
   topically anesthetize the eye.
- Pull back lids as when looking for 
   conjunctival foreign bodies, invert the 
   upper lid, and, if necessary instill 
   fluorescein dye (a last resort with soft 
   lenses, which absorb the dye tenaciously).
- If the lens is loose, slide it over the 
   cornea, and let the patient remove it in the 
   usual manner. Irrigation may loosen a dry, 
   stuck lens.
- For a more adherent hard lens, use a 
   commercially available suction cup lens 
   remover. Soft lenses may be pinched between 
   fingers or require a commercially available 
   rubber pincer.
 - Put the lens in a proper container (sterile 
   saline is always right).
 - Complete the eye examination, including 
   acuity, bright light and fluorescein 
   examination. Patch the eye if there is a 
   corneal abrasion.
- Instruct the patient not to wear the lens 
   until all symptoms have abated for 24 hours, 
   and to see his ophthalmologist if there are 
   any problems.

What not to do:
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 * Do not give up too easily. Lost lenses have 
   been excavated years later from under scar 
   tissue in the conjunctival recesses.
 * Don't omit the fluorescein step for fear of 
   spoiling a soft contact lens. The dye may 
   take a long time to elute out, but it is 
   more important to find the dislocated lens.

Discussion
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The deepest recess in the conjunctiva is under 
the upper lid, but lenses can lodge anywhere; 
there have been rare cases of lenses 
perforating the conjunctival sac and migrating 
posterior to the globe. Be sure to evert the 
upper conjunctival sac by pushing down with a 
cotton tipped applicator.

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