Farris R L
Department of Ophthalmology, College of Physicians and Surgeons, Columbia University, Edward S. Harkness Eye Institute, New York, New York 10037.
Cornea. 1990;9 Suppl 1:S44-6; discussion S47. doi: 10.1097/00003226-199010001-00018.
The practitioner's office can be an unsafe environment for fitting contact lens (CLs), owing to numerous reservoirs of microbial contamination. These include sinks, trial lenses, solutions, lens cases, multidose dropper bottles, and storage trays. Microbes may also be introduced to the eyes via the practitioner's fingers, the patient's lashes or lids, or cosmetic residues on the ocular adnexa. Because sterility is difficult to achieve in an office, CL fitters must accept the more realistic goal of disinfection. Periodic cultures are necessary to monitor the effectiveness of office hygiene and disinfection. Cultures are especially important, considering that the panel of organisms routinely used to test lens care solutions may not reflect those in office settings, which may become resistant to preservatives. It has been shown, for example, that 50% of chlorhexidine-preserved solutions used in offices can become contaminated with Serratia marcescens within 7 days of bottle opening. At present, it appears that contamination is best avoided by using solutions containing 15 ppm of polyaminopropylbiguanide (PAPB). Frequent replacement of solutions, trial lenses, and lens cases may also help to reduce the likelihood of microbial contamination in the office.
