ISMP Safe Medicine July/August 2010, Volume 8, Number 4. ©2010 ISMP

Brand name medicines appear in green; generic medicines appear in red.

Painful eye injuries with improper use of Clear Care solution

Many people who wear contact lenses clean and disinfect their lenses every day. There are a number of products available for this purpose, but they are not all the same. Usually, the products are stored side-by-side on supermarket and pharmacy shelves. If the wrong product is purchased and used incorrectly, eye injuries can occur.

Recently, a young woman was staying at a friend’s house. She noticed a bottle of contact lens solution in the bathroom. To the woman, the product (see Figure 1 in PDF version) looked like any other contact lens cleaning solution. The label had a picture of a contact lens on it, and it seemed to be the same shape and size as other contact lens solution bottles. She removed her contacts, placed them in her flat contact lens case, and added the solution found in her friend’s bathroom. The solution was CLEAR CARE (CIBA VISION, a Novartis Company), a cleaning and disinfecting product.

The following morning, the woman put one of the contacts in her right eye. She immediately had severe pain and burning in her eye. She tried to quickly remove the contact lens from her eye, but because of the severe pain, her eye was tightly squeezed shut. She eventually removed the lens and flushed her eye with water. The woman called her eye doctor and described what had happened. She told the doctor about the product she used to soak her lenses in her flat contact lens holder.

The woman’s doctor explained that Clear Care contains hydrogen peroxide. Hydrogen peroxide causes severe burning if put directly in the eyes or used to soak contact lenses in a regular flat lens case. Clear Care has a special lens case that must be used with this product. The Clear Care lens case has a built-in neutralizer—a ring of platinum that reacts with hydrogen peroxide—that causes the hydrogen peroxide to turn into water (see Figure 1 in PDF version). The entire process takes about 6 hours.

There are hundreds of descriptions on the Internet and reports sent to the Food and Drug Administration (FDA) describing the same problem the young woman had. Most incidents have occurred when people confused Clear Care with other lens care products, including saline, despite the following Clear Care label warnings:

- A red band at the top of the label on the bottle stating, “Use only lens case provided. Do not rinse lens with Clear Care prior to insertion.”

- A red paper ring on the neck of the bottle reads, “Use only lens case provided,” “Do not put Clear Care directly into the eye,” and “Do not rinse lens with Clear Care prior to insertion.”

- A red tip on the end of the bottle.
 
These label warnings may not be enough. We have encouraged the maker of Clear Care to make the product containers a different shape and/or color than typical cleaning or saline solutions. The difference in appearance would help decrease mix-ups. The carton should also have stronger warnings.

→Here’s what you can do: Talk to your eye doctor about the type of contact lens products you should use. Make sure you understand how to care for your lenses. When purchasing your lens care products, READ the package to make sure you have the correct product. If you use Clear Care, read the instructions carefully, use the special case provided for soaking your lenses, and make sure the lenses have been soaking for at least 6 hours before placing them in your eyes. Talk to your pharmacist if you have any questions about contact lens care products.