Ophthalmic Preparations

Preparations applied topically to the eye to treat

surface or intraocular conditions (infections of
the eye or lid, allergic or infectious
conjunctivitis, elevated intraocular pressure or
glaucoma, dry eye).
Types of ophthalmic preparations
1.
2.
3.
4.

Ophthalmic solution
Ophthalmic suspension
Ophthalmic ointments
Ophthalmic inserts (drug-impregnated and lenses)

 Normal volume of tear volume in the cul-de-sac is

7-8 l.
An eye that does not blink can accommodate to a
maximum of 30 l, but when blinked can retain
only about 10 l.
Because the capacity of the eye to retain liquid
and semisolid preparations is limited, topical
applications are administered in small amounts to
the eyelid (liquid dropwise and semisolid as a thin
ribbon).
A drop measures about 50 l (based on 20
drop/ml).
Large volumes may be used to bathe or flush the
eye.
Excess liquids (normally produced or externally
administered) drain fast.
2

 The optimal volume to administer, based on the

eye, capacity is 510 l drops. Since l-dosing eye
drops are not generally available for personal use,
loss of installed medication using standard eye
drops is a common occurrence.
Retention time of an ophthalmic solution is short,
the solution is flushed within 1-2 minute, and the
amount of drug absorbed is only a small fraction
of the quantity administered (less than 1%).
This necessitates repeated administration of the
solution.
Formulations that extend corneal contact time
(Gels, Liposomes, polymeric drug carriers,
ophthalmic suspensions and oinments) achieve:
Decreased frequency of administration.
Increased ocular retention time.
Increased bioavailability.

Pharmacologic Categories of
Ophthalmic Drugs

Anesthetics: To provide pain relief.

Antibiotic and antimicrobial agents: Used systemic and local to
combat ophthalmic infection.
Antifungal agents.
Anti-inflammatory agents: Used to treat inflammation of the eye.
Antiviral agents: Used against viral infections.
Astringents: Used in the treatment of conjunctivitis.
Beta-adrenergic blocking agents: Used topically in the treatment of
intraocular pressure and chronic open angle glaucoma.
Miotics and other glaucoma agents.
Mydriatics and cycloplegics: Allow the examination of the fundus by
dilation of the pupil. Mydriatics having a long duration of action are
termed cycloplegics.
Protectants and artificial tears: Used to lubricate the eye.
Vasoconstrictors and ocular decongestants: Used to soothe, refresh,
and remove redness due to minor eye irritation.

The preparation of solutions and

suspensions for ophthalmic use require
1.
2.
3.
4.
5.
6.
7.

Sterility.
Preservation.
Isotonicity.
Buffering.
Viscosity.
Ocular bioavailability.
Packaging.

Sterility and preservation:

Ophthalmic solutions and suspensions must be sterilized
for safe use.
Sterilization of ophthalmics in their final container by autoclaving
at 121 oC (250 F) for 15 minutes.
This method is precluded by the thermal instability of the
formulation.

Bacteria filters may be used.

They are not reliable as the autoclave.
Advantage is the retention of all particulate matter (microbial, dust,
fiber).

Testing the final product is used to validate the absence of

microbes, sterilization may be ensured by either method.
Preservatives are added to maintain sterility during use.
An exception is:
Preparations used during surgery or to treat traumatic eye because
some preservative irritate the eye.
These preservative-free preparations are packaged in single-use
containers.

 During preformulation studies, preservatives must

demonstrate:
Stability.
Chemical and physical compatibility with other formulation and
packaging components
Effectiveness at the concentration employed.

Among antimicrobial preservatives used:

Benzalkonium chloride

0.004-0.01%

Broad spectrum but incompatible with ionic drugs

Benzethonium chloride
Chlorobutanol

0.01%
0.5%

Cannot be autoclaved because it decomposes to hydrochloric acid

even in moderate heat.
This renders the product susceptible to microbial growth and alters
the pH and thereby affect the stability and/or physiologic activity of
therapeutic ingredients.

Phenyl mercuric acetate

Phenyl mercuric nitrate
Thimerosal

0.004%
0.004%
0.005-0.01%

In concentrations tolerated by the eye, all of the

mentioned preservatives are ineffective against
some strains of Pseudomonas aeruginosa
It can invade an abraded cornea and cause
ulceration and even blindness.
Preservative mixtures of benzalkonium chloride
(0.01%) and either polmyxin B sulfate (1000
USP Units/ml) or disodium ethylene diamine
tetra acetate (0.01-0.1%) are effective against
most strains of Pseudomonas.
The disodium ethylene diamine tetra acetate
which is commonly employed as chelating agent
for metals, renders strains of P. aeruginosa more
sensitive to benzalkonium chloride.
8

Buffered Isotonic Solutions

Osmotic pressure: The pressure responsible for the passage of
the solvent through a semipermeable membrane into the more
concentrated solution until equilibrium is established on both
sides of the membrane and an equal concentration of solute
exists on the two sides.
The concentration is concerned with the number of particles of
the solute in the solution (electrolyte or nonelectrolyte).
Body fluids (blood and tears) have an osmotic pressure
corresponding to that of a 0.9% solution of NaCl.
Solutions may be
Isotonic: When RBCs are mixed with a solution containing 0.9 %
NaCl, the cells retain their normal size.
Hypotonic (When RBCs are mixed with a solution containing 0.2 %
NaCl, the cells swell and finally burst with the liberation of
hemoglobin (hemolysis).; in the eye it causes water to pass from the
site of the topical application).
9

Hypertonic (When RBCs are mixed with a solution containing 2.0 %

NaCl, the cells shrink and become wrinkled or crenated.; in the eye it
draws water towards the site of the topical application through the tissues
of the eye).

Solutions for application to delicate membranes should be

adjusted to approximately the same osmotic pressure as that of
the body fluids (Isotonic).
Isotonicity value: The concentration of an aqueous NaCl solution
having the same colligative properties as the solution in
question.
Cell membrane of RBCs is not a perfect semipermeable
membrane. It permits the passage of solutes such as urea,
ammonium chloride, alcohol and boric acid.
A 2.0 % solution of boric acid is isosmotic with the blood. The
molecules of boric acid pass freely through the erythrocyte
membrane regardless of concentration. It is extremely hypotonic
with respect to the blood and brings about rapid hemolysis.
All solutions having an isotonicity value of 0.9 % NaCl of
solution need not be necessarily isotonic with respect to all
living membranes concerned. All may be considered isotonic10
with respect to an ideal membrane.

Measurement of Tonicity
1. Hemolytic method (a hypotonic solution liberates
oxyhemoglobin in direct proportion to the number
of cells hemolyzed). The vant Hoff i factor can be
determined.
2. A method based on any of the methods that
determine colligative properties. This method is
based on a measurement of the slight temperature
differences arising from differences in the vapor
pressure of thermally insulated samples contained
in constant humidity champers.
Freezing point of both the blood and lacrimal fluid
is -0.52 oC.
Freezing point of 0.9% NaCl is -0.52 oC (isotonic).
11

Calculating Tonicity Using Liso Values

L value can be obtained from the freezing

point lowering of solutions of representative
compounds of ionic type at a concentration c
that is isotonic with body fluids.
12

 The Liso for a 0.9% NaCl which has a freezing point

depression of 0.52 and is thus isotonic with body
fluids is

The interionic attraction in solutions that are not too

concentrated is roughly the same for all uni-univalent
electrolytes regardless of the chemical nature of the
various compounds of this class, and all have about
the same value for the Liso.
13

14

Example 9-11: What is the freezing point

lowering of a 1% solution of sodium
propionate (Molecular weight 96)?

15

Methods of Adjusting Tonicity and

pH
Class I Methods: Sodium chloride or some other substance
is added to the solution to of the drug to lower the freezing
point of the solution to -0.52 oC.
1. Cryoscopic Method
2. Sodium Chloride Equivalent Method
Class II Methods: Water is added to the drug in a sufficient
amount to form an isotonic solution. The preparation is then
brought to volume with an isotonic or buffered isotonic
dilution solution.
1. White-Vincent Method
2. Sprowls Method

16

Example 9-12: How much sodium chloride is

required to render 100 ml of a 1% solution of
apomorphine hydrochloride isotonic with
blood serum? Tf1% is 0.08oC.

17

Sodium chloride equivalent or the tonicic equivalent E of a

drug: The amount of NaCl that is equivalent to (has the
same osmotic effect as) 1 g, or other weight unit of the drug.

Thimerosal becomes less stable when a halogen salt is used

as an isotonic agent. Isotonic agents ( Mannitol, PG,
glycerin) that did not have detrimental effects on the
stability could serve as alternatives for NaCl.
To determine the amount of NaCl or other inert substance to
render the solution isotonic:
Multiply the quantity of each drug in the prescription by its
NaCl equivalent.
Subtract this value from the concentration of NaCL that is
isotonic with body fluids (0.9%).

1.
2.

18

Example 9-14: A solution contains 1.0 g of

ephedrine sulfate in a volume of 100 ml.
What quantity of NaCl must be added to
make the solution isotonic? How much
dextrose would be required for this purpose?
NaCl Equivalent of ephedrine sulfate is 0.23.
NaCl Equivalent of dextrose is 0.16.

19

Class II Methods
White-Vincent Method
1. Addition of water to the drug to make an
isotonic solution
2. Addition of an isotonic or isotonic-buffered
solution diluting vehicle to bring the solution
to the final volume
Example: Make 30 ml of a 1% solution of
procaine HCl isotonic with body fluids. E for
procaine HCl is 0.21.
20

Example 9-16: Make the following

solution isotonic with respect to an
ideal membrane. E for Phenacaine
hydrochloride is 0.2 and for boric acid
is 0.5 g.
Phenacaine hydrochloride...0.06 g
Boric acid0.30 g
Sterilized distilled water, enough to make.100 ml
21

Buffering

The pH of an ophthalmic preparation may be adjusted

for one or more of the following purposes:

For greater comfort to the eye.

To render the formulation more stable.
To enhance the aqueous solubility of the drug.
To enhance the drugs bioavailability by favoring the unionized
molecular species.
To maximize preservative efficacy.

The pH of normal tears is 7.4 but varies

Tears have some buffer capacity.
The introduction of a medicated solution into the eye
stimulates the flow of tears which attempts to neutralize
any excess hydrogen or hydroxyl ions.
Most of the drugs used ophthalmically are weakly acidic
and have only weak buffer capacity.
The buffering action of the tears neutralizes the
ophthalmic solution any thereby prevents marked
discomfort.
22

 The eye can tolerate greater deviation from the physiologic pH

towards the alkalinity than towards the acidic range.
For maximum comfort, the ophthalmic solution should have the same
pH as the tears. This is not pharmaceutically possible beacause at pH
7.4 many drugs are insoluble in water.
A few drug (pilocarpine HCl and epinephrine bitartrate) are quite acid
and overtax the buffer capacity of the tears.
A compromise pH is generally selected is generally selected for a
solution and maintained by buffers to permit the greatest activity while
maintaining stability.
An isotonic phosphate vehicle prepared at the desired pH and adjusted
for tonicity may be employed in the extemporaneous compounding of
solutions.
This vehicle is not suitable for pilocarpine, eucatropine, scopolamine
and homatropine which show instability in the vehicle.
When drugs are added directly to the isotonic phosphate vehicle, the
solution becomes slightly hypertonic, generally this produces no
comfort to the patient.
If not desired, the adjustment can be made through calculated dilution
of the vehicle with water.
23

Viscosity and thickening agents

Viscosity: property of liquids related to the resistance to
flow (fluidity is the reciprocal of viscosity).
The viscosity of water (reference) at 20 oC is given as 1
centipoise.
The viscosity decreases with increasing the temperature.
A thickening agent is frequently added to increase the
viscosity and thereby aid in maintaining the drug in
contact with the tissues to enhance therapeutic
effectiveness.
Generally

MC 4000 cps viscosity type is used in concentrations of 0.25%.

MC 25 cps viscosity type is used in concentrations of at 1%.
HPMC.
PVA.

Viscosity for ophthalmic solutions is considered optimal in

the range of 1525 cps.
24

Ocular bioavailability
Factors affecting ocular bioavailability
Physiological factors
Protein binding:
Normally tears contain 0.6-2% protein, including albumin and
globulins but disease state can raise these levels.
Protein-bound drugs are incapable of penetrating the corneal
epithelium because of their size.
Protein binding is reversible but tear turnover results in loss of
both bound and unbound drug.

Drug metabolism:
Tears contain enzymes (lysozyme) capable of metabolic
degradation of drug substances.
The full extent to which the metabolism occurs and affects
therapeutic effectiveness is undetermined.

Lacrimal drainage (1st order kinetics in which the rate is

proportional to the concentration, 80% of administered dose).
25

- Other factors, such as physicochemical

characteristics of the drug substance and product
formulation, are important.
The cornea is a membrane barrier containing
both lipophilic and hydrophilic layers. It is
permeated most effectively by drug
substances having both lipophilic and
hydrophilic characters.
Ophthalmic suspensions, gels, and ointments
mix with the lacrimal fluid less readily than
do low-viscosity solutions and remain longer
in the cul-de-sac, enhancing drug activity.
26

- Other considerations
Ophthalmic solutions must be clear and free of
particulate matter for comfort and safety.
The formulation of ophthalmic suspension is
undertaken when:

It is desired to prepare a product with extended

corneal contact time.
The medicinal agent is insoluble in an aqueous
vehicle.
The medicinal agent is unstable in an aqueous
vehicle.

Drug particles

Must be finely divided, usually micronized, to

minimize eye irritation and/or scratching of the
cornea.
Must not associate into larger particles upon storage.
Must be easily and uniformly redistributed by gentle
27
shaking of the container prior to use.

Packaging Ophthalmic Solutions and

Suspensions
Ophthalmic solutions and suspensions are packaged in:
Small glass bottles with separate glass or plastic dropper (few)
Soft plastic containers with a fixed built-in dropper (most).

The later is preferred both to:

Facilitate administration.
Protect the product from external contamination. The screw-type
bottles are fully opened when in use.

Each type is subject to contamination during use by:

Airborne contaminants.
Inadvertent touching of the tip of the dropper to the eye, eyelids,
or other surface

Ophthalmic solutions and suspensions are packaged in

containers holding 2, 2.5, 5, 10, 15 and 30 ml of the
product.

28

Proper Administration of Ophthalmic

Solutions and Suspensions

The patient should be advised to :

Wash hand thoroughly with soap and water.

Inspect the dropper (separate) to make sure that it has no chips or cracks.
Inspect ophthalmic solutions for color and clarity.
Discard out of date or darkened solutions.
Ophthalmic suspensions should be shaken thoroughly prior to
administration to distribute the suspensoid evenly.

The cap of the dropper should be removed immediately prior to use

and returned immediately after use.
The combined dropper with container is used by holding it between
the thumb and middle finger with the index on the bottom of the
container.
A product packed with a separate dropper is used by holding the
dropper between the thumb and the forefinger then drawing and
discharging the medication.
29

 To instill eye drops, the person should:

Tilt head to back
With the index finger of the free hand, gently pull
downward the lid of the affected eye to form a pocket
or cup.
While looking up, and without touching the dropper to
the eye, the prescribed number of drops are instilled
into the formed pocket.
Release the lower lid and close the eye to allow the
medication to spread over the eye (preferably a full
minute without blinking, rubbing or wiping).
Gently apply pressure just under the inner corner of the
eye by the nose to compress the nasolacrimal duct to
prevent drainage and enhance the contact time.
Wipe away the excess liquid with a tissue.
30

 During handling and administration, care must be taken

not to touch the dropper to the eye, eyelid, or any other
surface.
If separate dropper is used, it should be returned to the
container and capped tightly. The dropper should not be
rinsed or wiped off.
If a combined dropper and container unit is used, the
container cap should be returned and tightly closed.
The patient should be advised about the:

Correct number of drops to instill.

Frequency of application.
Duration of treatment.
Proper storage of the medication.
Usual side effects to the product (Transient stinging or burning,
foreign body sensation, itching, tearing, decreased vision, margin
crusting, occasionally bad (drug) taste).
31

Ophthalmic ointments
Ointments are greasy, semisolid preparations often anhydrous and
containing dissolved or dispersed medication.
Base requirements:

Non-irritating.
Permit diffusion of the drug.
Usually melt or soften at body temperature.
Mixture of petroleum & liquid petroleum.
Sometime water miscible base may be used (lanolin).

Ophthalmic ointments increase the ocular contact time 2-4 times

They result in blurred vision therefore they should be applied at bed
time.
Ophthalmic ointments must be sterile
Using sterile ingredients and compound under aseptic condition
Sterilization after manufacturing

Container should be a sterilized tin or plastic ophthalmic tube, small

contains about 3.5g and has a narrow gauge tip to deliver a narrow
band of ointment
32

 Proper administration of ointment

Tilt head to back
Hold the tube between the thumb and the index,
close to the eye.
With the index finger of the free hand, gently
pull downward the lid of the affected eye to
form a pocket or cup.
While looking up, and without touching the tip
to the eye, apply a thin ribbon of the medication
into the formed pocket.
Release the lower lid and close the eye to allow
the medication to spread over the eye
Blink and remove excess ointment.
33

Ophthalmic inserts
They consist of inner core of the drug surrounded by
copolymer membrane through which the drug
diffuses (pilocarpine ocusert).
Membrane thickness and composition determine the
release rate.
Elliptical in shape (usually 13.4 x 5.7 x 0.3 mm).
Flexible.
They eliminate frequent, nighttime administration,
enhance compliance and reduce dose
Must be sterile and contains no preservative
34

Contact Lenses and Care and Use

Solutions

1.

Three basic types classified by their chemical composition

and physical properties into:
Hard contact lenses
Made of a rigid plastic resin, polymethylmethacrylate
(PMMA).
They are 7-10 mm in diameter and designed to cover only
part of the cornea.
They float on the tear layer overlying the cornea.
If they rest directly on the corneal surface they cause
physical damage to the epithelial tissue.
To prevent direct contact, solutions are used to wet the
lens and provide a cushioning layer between the corneal
epithelium and the inner surface of the lens
35

 Impermeable to oxygen and moisture (absorb only 0.5%

water), affecting corneal respiration and discomfort.
Advantages:
Provide strength, durability and relatively easy care regimen.
They are easy to insert and remove and are relatively resistant to
absorption of medications, lens care products, and environmental
contaminants.
Provide visual acuity superior to that provided by soft contact
lenses

Disadvantages:
They require an adaption period for the wearer (as long as a
week).
More easily dislodged from the eye.

2. Soft contact lenses

Made of hydrophilic transparent plastic, hydroxyethyl
methacrylate (HEMA) with small amounts of cross-linking
agents that provide a hydrogel network.

36

 Range from 13-15 mm in diameter and cover the entire

cornea thus less likely to dislodge spontaneously.
Contain 30-80% water which enhances permeability to
oxygen.
They Less likely to permit irritating foreign particles to
lodge between them.
Advantages:
Shorter adaptation period
May be worn comfortably for longer periods.
They do not dislodge as easily or fall out of the eye as readily as
the hard lenses.

Disadvantages:
They have shorter life span than hard or RGP lenses.
The wearer must ensure the lenses do not dry.
They do not provide the same high level of visual acuity as hard
lenses.
Carry some risk of adsorbing medication concomitantly applied to
the eye.
37

 There are two general types of soft contact

lenses
Daily wear: Must be removed at bedtime.
Extended wear: Designed to be worn for more
than 24 hr (some approved for 30 days)
It advised not to be left in eye the more than 4-7
days without removal for cleaning and disinfection
(predisposing to eye infection).

Disposable soft lenses do not require

cleaning and disinfection for the
recommended period of use.
Patients should be advised to resist any
temptation to wear the lenses longer than
recommended to avoid eye infection.

38

3. Rigid gas permeable contact (RGP) lenses

They are oxygen permeable but
hydrophobic. Thus, they permit greater
movement of oxygen through the lens
while retaining the characteristic durability
and ease of handling.
More comfortable than hard lenses.
The basic type is intended for daily wear,
some of the new permeable RGP lenses
are suitable for extended wear.
Advantages and disadvantages as per hard
39
contact lenses.

Care for contact lenses

It is important that contact lenses receive
appropriate care to
Retain their shape.
Retain their optical characteristics.
For safe use.

Wearers should be instructed in the techniques for

insertion and removal of the lenses and in methods
of cleaning, disinfecting and storage.
Product for soft contact lenses
1. Cleaners
Because of their porous composition, soft lenses
tend to accumulate proteins that form a film on the
lens, decreasing clarity and serving as a potential
medium for microbial growth.
40

 Cleaners are two main categories:

Surfactants which emulsify accumulated oils, lipids and
inorganic compounds.
Enzymatic cleaners which break down and remove
protein deposits

2. Rinsing and storage solutions

Saline solutions for soft lenses (0.9% NaCl) should have a
neutral pH and be isotonic with tears.
Some saline solutions contain preservative (eye irritation).
Preservative-free saline solutions are made available and
stored in aerosol container or unit of use vials.
The use of salt tablets to prepare saline solution is
discouraged because of the potential for contamination and
risk of serious eye infection.

41

3. Disinfection and neutralization

Thermal (heat):
- lenses must be thoroughly cleaned before using heat disinfection
otherwise heating can hasten lens deterioration.
- lenses are placed in specially designed heating unit with saline
solution and heated sufficiently to kill microorganisms (for 10
minute at 80oC).

Chemical:
- Previously conducted with products that contained thimerosol, in
combination with either chlorhexidine or a quaternary ammonium
compound (sensitivity reactions).
- H2O2 was introduced. To prevent eye irritation from residual H 2O2,
the lenses must be exposed to a neutralizing agent.

Products for hard contact lenses

1. Cleaners: A surfactant cleaner is used (solution or gel).
2. Soaking and storage solution
Contain sufficient concentration of disinfecting agent, usually
0.01% benzalkonium chloride and 0.01% edetate sodium to kill
bacteria.

42

3. Wetting solution

Contain surfactant to hydrate the hydrophobic lens

surface and enable the tear to spread evenly over the lens.
Provide a cushion between the lens, cornea and eyelid
Typical ingredients include viscosity-increasing agent
(HPMC), wetting agents (PVA), preservative
(benzalkonium chloride or edetate sodium) buffering
agents and slats to adjust pH and maintain isotonicity.

Combination solution
They mix effects, such as cleaning and soaking, wetting
and soaking or cleaning, soaking and wetting.
They may lower the effectiveness of cleaning if the
concentration of the cleaning solution is low to
adequately remove the debris from the lens.
They should be reserved for wearers who need
simplification of lens care.
43

Products for RGP contact lenses

Care requires the same general regimen as for hard
contact lenses except that RGP-specific solutions must be
used.
Clinical considerations in the use of contact lenses:
Most medicated eye drops may be used in conjunction
with the wearing of contact lenses.
Caution should be exercised and drug-specific information
used, particularly with soft contact lenses, because they
can absorb certain topical drugs and affect bioavailability.
Use of ophthalmic suspensions and ophthalmic ointments
presents some difficulties.
Drug particles in ophthalmic suspensions can build up between the
cornea and the contact lens causing discomfort and other side
effects.
Ophthalmic ointments cloud vision and may discolor the lens.

Alternative dosage form (solution) may be prescribed or

lens wearing deferred until therapy is complete.

44

 Drugs excreted in tears can produce drug-contact lense

interaction. They may result in lens discoloration (orange staining
by rifampin), lens clouding (ribavirin), ocular inflammation
(salicylate) and refractive changes (acetazolamide).
Drugs that cause ocular side effects have a potential to interfere
with the contact lens use
Drugs that reduce tear secretion may cause lens intolerance and damage to
the eye (anticholenergic effect like antihistamine, tricyclic antidepressant).
Isotretinoin prescribed for acne, can induce marked dryness of the eye.
Drugs that promote excessive lacrimation (reserpine) or ocular or eyelid
edema (primidone, hydrochlorothiazide, and chlorthalidone).
Vasoconstrictors occasionally causes dilation of the pupil, especially in
people who wear contact lenses or whose cornea is abraded. FDA
recommended product labeling (PUPILS MAY BECOME DILATED
(ENLARGED)).

45

 Guidelines used by pharmacists when counseling

patients:
Wash hands thoroughly with a nonabrasive,
noncosmetic soap before and after handling lenses.
Not to rub the eyes when lenses are in place.
If irritation develops, the lenses should be removed
until these symptoms subside.

Only contact lens care products specifically

recommended for the type of lens worn should be
used.
Cleaning and storing should be performed in the
specific solutions for a that purpose, not in tap
water.
Saliva should not be used to help reinsert a lens
into the eye (not sterile and contains P.
aeruginosa).
46

 Counseling with regard to cosmetic use:

Purchase make up in the smallest container to minimize the likelihood of
bacterial contamination should to maintain sterility.
Mascara and pearlized shadow should be avoided because particles can
get into the eye and cause irritation and possibly corneal damage.
Aerosol hair spray should be used before insertion of contact lenses and
preferably applied in another room (airborne particles may attach to the
lens and cause irritation).
Lenses should be inserted before makeup application and removed before
its removal (oily substances on the fingertips can smudge the lenses).

Wearers normally do not have ocular pain. Pain is a sign of illfitting lenses, corneal abrasion, or other medical conditions. The
patient should be advised to counsel his ophthamologist.
Hard or soft contact lenses may occasionally cause superficial
corneal changes (painless and not evident to the patient)
therefore the eyes should be examined regularly to make certain
that no damage has occurred.
47