editor's perspective
Swimming While Wearing Contact Lenses
BY JOSEPH T. BARR, OD, MS, FAAO, EDITOR

I wear contact lenses when I ride my bike, play golf, and swim. There is plenty of literature on the safety of wearing contact lenses while swimming and the risks are certainly obvious. One of my physiology professors often said it's good to go back to first fact. The first fact here is that a contact lens could alter the ocular surface, alter the epithelium and thus offer an opportunity for a micro-organism in or near a pool, lake, ocean or hot tub, and the result could be a nasty, sight-threatening infection. The lens could offer a surface, unlike the eye itself, to colonize micro-organisms which would then infect the eye. But infections after swimming with contact lenses in place are rare.

Obviously contact lenses could fall out of ones eyes while swimming. This is more likely for rigid lenses than for soft hydrogel lenses. Watertight swimmers goggles or a diving mask help prevent loss and protect. Indeed, hydrogel lenses that become hypotonic when exposed to water during swimming may adhere to the ocular surface due to osmotic effects. Thus, hydrogel lenses should have time to equilibrate after swimming, or one should use sterile saline or lens lubricant eye drops to help bring the lens back to a nearly isotonic state prior to removal. Rinsing and using eye drops after swimming helps to rinse away contaminants and improve comfort as well.

Numerous reports have demonstrated the safety of diving while wearing contact lenses, even though bubbles may form behind the lens. Typically these bubbles are transient and not injurious, but long-standing dimple veiling may case epithelial erosion. Nevertheless, diving or snorkeling while wearing contact lenses is common and a good experience.

One should not sleep with lenses on the eyes after swimming. If lenses are reused after swimming, they should be cleaned and disinfected, preferably with a lens care system with a history of effectiveness against Acanthamoeba.

Recently, three of four cases of infectious keratitis, the first cases reported in the literature with silicone hydrogel lenses, found that three of four young males had been swimming while wearing their lenses within weeks prior to their infection. Was this the cause of their infection? There is no way to be sure. But it may point out the importance of lens removal, rest and lens disinfection prior to rewearing lenses after swimming, especially when using lenses for extended or continuous wear.

These observations lead us to consider the value of daily disposable soft lenses or overnight contact lens corneal reshaping for swimmers.