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Clinical Care and Practice Advancement
Occupational Vision Manual Part I: Introduction

Occupational Vision Manual: Part IV: Contact Lens Use In Industry



by: Robert A. Koetting, O.D.

Part I | 2 | 3 | 4 | 5 | 6

The use of contact lenses in industrial settings has been controversial since the early 1960s. Authors debated the pros and cons of wearing contact lenses in environments posing great risk of eye injury (Kuhn, 1961; Silberstein, 1962). The potential for contact lenses to increase both the number and severity of eye injuries in industry led the National Society to Prevent Blindness to recommend that contact lenses be prohibited for wear in industrial environments (NSPB, 1972).

The ANSI Z-80 Subcommittee on Contact Lenses addressed the question of the safety of wearing contact lenses in industry in 1972. The discussions led to a survey of practitioners to determine the extent of eye injuries associated with contact lens wear (Rengstorff and Black, 1974). Rengstorff and Black reported on 128 documented incidents in which individuals wearing contact lenses were exposed to physical trauma or chemical irritation. In not one of the cases did the reporting practitioner believe that the eye injury was caused, or made worse, by the wearing of a contact lens. In fact, in many cases the practitioners believed that the contact lens provided some protection.

During the 1970s and 1980s, researchers tried to simulate injuries resulting from industrial-type hazards in subjects (often rabbits) wearing contact lenses (Guthrie and Seitz, 1975; Lovsund et al., 1979; Nilsson et al., 1981; Nilsson and Andersson, 1982; Nilsson et al., 1983). These studies overwhelmingly showed that wearing contact lenses does not place the eyes at special risk of injury in industrial-type settings. Nevertheless, these studies were typically performed in laboratory settings, using research protocols. One can only speculate on the influence of the human element and a worker’s possible noncompliance with other safety standards in actual settings.

One thing is clear, however, and it is something on which everyone agrees: "Contact lenses of themselves do not provide eye protection in the industrial sense." (ANSI Z87.1-1989). OSHA-mandated and ANSI-recommended eye protection must be worn over contact lenses exactly as if the worker required no refractive correction. Moreover, when environmental conditions cause discomfort or interfere with vision (e.g. such as smoky, dirty, or dusty conditions), extra protection (e.g. such as fully sealing goggles instead of spectacles with side shields), may be needed.

Whether workers should wear their contact lenses around potentially toxic chemicals continues to elicit varying points of view. Although studies have shown that contact lenses do not worsen chemical injuries (Wesley, 1966; Rengstorff, 1969; Nilsson and Andersson, 1982; Kok-van Alphen et al., 1985), these studies often did not take into account the human element. If a chemical is splashed into the eye of a worker wearing a contact lens, valuable time may be lost before the eye is flushed with water, while the worker tries unsuccessfully to remove the lens or fails to rinse the eye at all, for fear of losing the lens (Kingston, 1981). In such a scenario, additional injury may occur.

Another situation that warrants discussion is that in which a worker is unable to call "time-out" when he or she becomes visually incapacitated by debris under a contact lens. For example, consider a welder working on scaffolding or on an I-beam. If smoke or welding debris gets trapped behind the contact lens and incapacitates the worker, he or she may be at extra risk of injury from a fall, burn, or even electrocution. Care must be exercised when authorizing contact lens wear for industrial workers. Workers, coworkers, and safety personnel must be apprised of the risks and responsibilities that accompany contact lens wear. Education of all individuals involved is an important first step in developing a contact lens policy for industry. The AOA’s Guidelines for The Use of Contact Lenses in Industrial Environments should be reviewed (Appendix B). It lists the questions that should be asked and answered in arriving at an informed decision concerning contact lens use.