12.3 Hygiene, Soaps, Cosmetics & Storage Containers

Hygiene, Soaps, Cosmetics & Storage Containers

Quick Answer: Wash hands with non-cream soap and a lint-free towel; insert lenses before makeup and remove them before makeup removal; use hypoallergenic water-based cosmetics and avoid waterproof mascara; replace the lens case every 3 months, air-dry it open, and never top off solution.

Hygiene failures are the leading cause of contact lens-induced complications including microbial keratitis, giant papillary conjunctivitis, and deposit-driven discomfort. The CLRE expects you to know the specific rules, not generic advice.

Hand Hygiene

Proper Hand Washing Steps

1. Wet hands with warm water.
2. Apply non-cream soap — work into a lather up to the wrists.
3. Rinse thoroughly — soap residue on the finger pad transfers directly onto the lens surface.
4. Dry with a lint-free towel — paper towels and terrycloth shed fibers.
5. Avoid touching non-clean surfaces (faucets, door handles) before handling the lens.

Soaps to Avoid

Acceptable options: plain bar soap, mild liquid dish soap diluted, or ophthalmic-grade hand washes.

Cosmetics Rules

Insertion/Removal Sequencing

Cosmetics Selection

• Hypoallergenic, water-based cosmetics are preferred.
• Avoid waterproof mascara — typically oil-based, difficult to remove, and splashes during removal can stain or deposit on lenses.
• Avoid fiber or lengthening mascaras — fibers shed into the tear film and adhere to the lens.
• Powdered eye shadow is preferable to cream — fewer migrating particles.
• Eye pencils should be sharpened regularly.

Application Boundaries

Eye makeup must be applied outside the lash line, never on the inner rim (waterline):

• Inner-rim application risks contamination of the tear film and lens.
• It can obstruct or infect the meibomian gland orifices, worsening dry eye — a common lens-wear complicator.
• For the same reason, eyeliner should not be applied at the lid margin — keep it on the skin above the lash roots.

Hairspray and Aerosols

• Apply hairspray before inserting lenses, or have the patient close their eyes and leave the room during application.
• Aerosol droplets adhere strongly to lens surfaces and cause coating that no cleaning solution fully removes.

Lens Case Hygiene

Replacement Schedule

• Replace the lens case every 3 months — sooner if visibly soiled or cracked.
• Cases develop biofilm within weeks; routine cleaning does not fully remove established biofilm.
• Manufacturer-provided cases often include a replacement reminder sticker.

Daily Case Care

1. Empty the old solution from both wells (never top off).
2. Rub the inside of each well with a clean finger.
3. Rinse with fresh multipurpose solution (never water).
4. Air-dry open — capping a wet case traps moisture and accelerates biofilm growth.
5. Store the dry case open or with the caps off between uses.

Critical Prohibitions

Storage Environment and Travel

Where the case lives matters as much as how it is cleaned. The case should be stored in a clean, dry, well-ventilated location — never in a humid bathroom where airborne moisture feeds biofilm, and never in a sealed bag or container that traps humidity. Travel kits should include a small bottle of fresh solution (never decanted into an unlabeled bottle), a spare case, and non-cream soap wipes; patients should never transfer solution into contact-lens-unapproved containers because preservative concentration and sterility cannot be guaranteed. Heat exposure (a car glove compartment in summer) warps soft lenses and degrades solution preservatives, so advise patients to carry lenses in an insulated bag. Finally, diagnostic lenses kept in the office must be stored in dedicated disinfecting solution and rotated per the manufacturer's expiration date — never used past expiration even if the lens looks clear.

Patient Education Summary

A helpful patient-facing checklist:

1. Wash hands with plain soap, dry with lint-free towel.
2. Insert lenses before makeup.
3. Use hypoallergenic, water-based cosmetics.
4. Apply makeup outside the lash line.
5. Apply hairspray before lenses, or close eyes.
6. Remove lenses before makeup removal.
7. Empty, rub, rinse, air-dry the case daily.
8. Replace the case every 3 months.
9. Never top off solution; never use water.

Key Takeaways

• Plain, non-cream soap and lint-free towels are mandatory.
• Insert before makeup; remove before makeup removal.
• Use hypoallergenic water-based cosmetics; avoid waterproof mascara.
• Apply eye makeup outside the lash line to protect meibomian glands.
• Replace the lens case every 3 months; air-dry open; never top off solution.