A burning problem with hydrogen peroxide lens solutions

 

Some contact lens cleaning solutions contain hydrogen peroxide, which should never be used directly in the eye or as a rinsing solution for lenses. When these solutions are used as a cleaning and soaking agent, the lenses must be placed in a special lens case provided with the solution to neutralize the hydrogen peroxide gradually over 6 hours. The lenses can be safely placed back in the eyes only after soaking for 6 hours in the special case, not in a typical lens case. If the hydrogen peroxide is not neutralized, or if the solution is used only to rinse the lens or put directly in the eye, it will cause severe burning and pain. It may even result in severe eye injuries.

Since 2010, ISMP has repeatedly warned consumers about the risk of painful eye injuries if these solutions are used incorrectly. Unfortunately, the problem continues today, even though warnings have been added to the outer and inner labels. Our previous alerts described eye injuries with Clear Care (Figure 1) or Clear Care Plus, but errors have also happened with generic products that contain hydrogenClear Care for article peroxide. These products are often stored near other contact lens solutions (e.g., saline, multipurpose disinfectant). Most of the errors involve someone mistakenly selecting a hydrogen peroxide solution, thinking it is a familiar lens soaking or rinsing product. Labels may have warnings to never rinse lenses with the product, to never put the product in the eyes, and to only use the special (enclosed) lens storage case. But these warnings are easily overlooked.

In one of the recent cases reported in late 2020, a woman was having difficulty removing her left lens at bedtime and decided to flush it out. She grabbed a bottle of what she thought was a lens rinsing solution, but it was actually Clear Care. She had already removed her right contact lens and was not able to clearly read the label, but the bottle in hand looked similar to her rinsing solution. Within a few seconds of rinsing her eye with the Clear Care solution, she experienced extreme pain and burning. She grabbed the correct bottle of rinsing solution, but no amount of rinsing helped relieve the pain. She woke up in the morning with a red, swollen, and tearing “burned” eye. This woman joins thousands of others who have experienced eye injuries when using Clear Care, Clear Care Plus, or other similar generic hydrogen peroxide lens cleaning solutions. In fact, we have heard from people who still experience symptoms, including excessive tearing, years after the event. We even heard from one woman who required the placement of lacrimal stents to open her tear ducts.

We continue to encourage the manufacturers of hydrogen peroxide contact lens solutions to make the product containers a different shape and/or color than typical cleaning or saline solutions. We also encourage manufacturers to clearly highlight the correct use of their products on the labels so that users will see it right away. The US Food and Drug Administration (FDA) agrees that improvement is needed, but the process is slow, particularly given current FDA attention on coronavirus disease 2019 (COVID-19) treatments, vaccines, and testing. To date, Alcon, the maker of Clear Care and Clear Care Plus, has not agreed to any labeling or packaging changes. This means that other companies that manufacture generic lens solution products containing hydrogen peroxide are also not required to make any labeling or packaging changes.

Here’s what you can do: If you wear contact lenses, do not assume all contact lens solutions are the same! Check and read package labels carefully before purchasing or using any contact lens product. Before you remove your contact lenses for cleaning or rinsing, carefully read the manufacturer’s instructions for the product you have selected, and follow the instructions, step by step.

If you use Clear Care, Clear Care Plus, or a comparable generic hydrogen peroxide product, make sure you always use the special case that comes with the product, and soak your lenses for the amount of time indicated in the instructions to ensure full neutralization of the hydrogen peroxide. Always use a new case when you open a new bottle of solution. An old case will not neutralize the hydrogen peroxide as well as a new case. Never rinse your contact lenses with Clear Care, Clear Care Plus, or another hydrogen peroxide solution immediately before placing them in your eyes.

To avoid mix-ups at home, keep lens cleaning solutions containing hydrogen peroxide in a location separate from where you keep solutions used to rinse or moisturize your lenses.

Created on February 23, 2021

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