Contact lens cases: the missing link in contact lens safety?

PURPOSE: To summarize a variety of issues associated with contact lens case contamination and discuss appropriate methods that can limit this.
METHODS: A literature review was undertaken investigating the major factors associated with case contamination, with specific reference to the major pathogens associated with contamination, the role of bacterial biofilms, and methods that can limit contamination.
RESULTS: The use of antimicrobial cases, regular case cleaning and case replacement, avoidance of topping up solutions, and not using tap water to rinse cases all appear to be important in avoidance of significant case contamination.
CONCLUSIONS: Contact lens case contamination is a significant public health concern and may contribute significantly to the development of microbial keratitis in contact lens wearers. Patients should be reminded that they must clean and disinfect their lens cases daily, should avoid the use of tap water for rinsing them, must not top up their solutions, must take into careful consideration where and how the cases are stored during the time that lenses are being worn and that they must be replaced regularly. The adoption of these methods will substantially reduce the levels of contamination of cases with pathogenic microbes.