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Hard Lenses – insertion

  • Post at: April 08, 2009
  • By: dodo
  • Category: Conjunctiva, Cornea, Eyelids

The majority of patients have become wholly relaxed about putting on and removing lenses by the time they attend for the first follow-up appointment. Many, at that stage, are able to treat the matter as a joke and refer to their former anxieties with amusement or mild embarrassment. A minority, however, are still having some difficulties and in a small proportion of cases these difficulties may persist — sometimes because the wearer has never had proper instruction.

Putting a contact lens on a cornea is no more difficult than putting it on the tip of your finger but, in practice, there are several factors that can frustrate you. The first is that the eyelids can, and probably will, get in the way long before you can get near the surface of the cornea with your lens. This is a perfectly natural response and is exactly what you have been doing all your life, whenever your eye is threatened. Many experienced contact lens wearers so thoroughly learn to block this impulse that they can keep the eye wide open, without touching the lids, while placing the lens on to the cornea. But very few beginners can expect to perform this feat, so it is necessary, at least at first, to hold the lids open. Because the lid skin is very elastic and just underneath is an important flat muscle which can bring the lid margins together even if the skin is held, the only way to keep them securely apart is to hold them either very near the margins (difficult if the skin is not quite dry) or to secure them by trapping the lashes.

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One easy method of holding up the upper lid (which is the larger and more important) is to look right up so that the lashes of the upper lid come to rest just under the bone edge and then to press the centre of the row of lashes up against the bone with the middle finger of your free hand. This gives you extremely effective exposure when you look downwards, as the upper lid is prevented from following the eye down in its normal fashion. All that is necessary now is to pull down the lower lid a little, with a finger placed centrally just below the lid margin, and the whole of the cornea will be widely uncovered. By using the middle finger you leave the index finger free to carry the lens. Note the emphasis on central placement of both restraining fingers: it is no good holding the corner of the lid as this will allow the centre to sag across the cornea.

So far so good. You have now learned how to expose the whole of the cornea; but all this effort will be wasted if you turn your eyes to the side or up or down. No matter how effectively you hold your lids apart, you will still be able to get your cornea behind the lid edges so that it will be impossible to get a lens on.

All this may seem too obvious to be worth mentioning, but the reason I do mention it is that, time after time, patients secure their eyelids perfectly then frustrate the whole endeavour by rolling their eyes, usually right upwards, but sometimes to the side. Fortunately, there is an easy way out of this problem. If your lids are properly held and if the contact lens is brought up to the eye on the tip of the index finger, so that you can look straight into it, and if you continue to look straight into it until it is on your eye, then it can only go on one place — where it should go, right on to the centre of your cornea. If you are not looking straight into the lens when applying it to the eye, it will not land on the cornea.

So this is another psychological barrier which has to be overcome, and don’t be surprised if you have a bit of difficulty to start with. It goes against all instinct to stare straight at something that is getting nearer and nearer to your eye, with the evident intention of actually touching it! But it is amazing how a reflex habit of a lifetime can be overcome when you find that neither discomfort nor harm is involved.

The method I have suggested of securing the eyelids is probably the best, but some people find it awkward and prefer to hold the lids open with the fingers of one hand while bringing up the lens on a finger of the other hand, because they find it easier to control the finger on which the lens is sitting if that hand is free. It does not matter very much how you do it, so long as you really are keeping the lids wide apart and are keeping the cornea well centred.

One thing you should avoid, however, is holding the lens on a rigid rubber or plastic sucker when putting it on the eye. With such a device you are much more likely to bang the lens painfully against the cornea than if it is resting on the soft pad of your finger. I don’t advise using suckers to remove the lenses either.

While I am very much in favour of your using a method which enables you to put the contact lens directly on to the cornea, I would not like to suggest that there is no other way of getting the lens there. Some people find it very difficult to place the lens directly on to the cornea and, perhaps because they have found themselves repeatedly rolling the eyes upwards (consequently depositing the lens on the conjunctiva below the cornea), have settled for a method of doing this deliberately and then gently pushing the lens up on to the cornea. This is all right if it is done properly, but remember that the cornea bulges out fairly steeply and the edge of the lens may strike sharply against the start of the corneal curve as you push it up. If you prefer this method, the right way is to pop the lens on to the conjunctiva immediately below the cornea then, by pressing through the lid, on to the lower edge of the contact lens, to tilt the upper edge of the lens a little way clear of the eye and then push it up on to the cornea. The whole manoeuvre is done by gentle pressure through the lid.

Incidentally, if you have to move a contact lens which has been displaced from the cornea and is lying on the white of the eye, this is how to do it. Simply feel the lens through the lid, moving your eye in the opposite direction, as necessary. Even if the lens has travelled right up under the upper lid, so that it is barely visible or even completely concealed by the lid, it will be quite easy to slip it forward and down just by looking downwards and gently pushing the lens down with the finger tip placed on the outside of the lid.

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