This page is to help parents and guardians of babies and young children who attend Moorfields contact lens clinic understand how and why contact lenses are used in this age group.
Reasons for fitting contact lenses in children
Moorfields’ fit children with contact lenses for a wide variety of eye conditions. The majority are young children who require contact lenses after cataract removal, but we also provide contact lenses for children with other conditions such as very high degrees of short or long-sightedness, keratoconus, albinism, and eyes with an unusual or atypical appearance where coloured contact lenses are fitted to normalise the appearance and therapeutic lenses. Not all children who come to the department are suitable for lenses. If this is the case, your child will not be fitted.
Contact lenses in children who have had cataract surgery
In a normal eye the cornea (front window of the eye) and the lens focuses objects on the retina for clear vision. The lens should be transparent and is able to change its focus for close or far away vision.
In a cataract, the lens is opaque (cloudy) which prevents light from reaching the retina, causing the vision to be blurred. Cataract surgery removes the opaque lens, allowing light to reach the retina, which is important for normal visual development in children.
During cataract surgery, the opaque natural lens may be replaced by an intra-ocular lens (implant). If this is not possible, the focussing power of the lens must be replaced, either with spectacles or contact lenses. Although spectacles can work very well after surgery, the spectacles lenses need to be thick, which can be difficult and heavy for very small children and may restrict their field of vision. Therefore, contact lenses are often used. A pair of spectacles are usually ordered as a back-up for times when the contact lenses are not able to be worn.
Unlike the normal lens of the eye, contact lenses and implants cannot change focus from near to far, so we have to choose where to focus the vision in children after cataract surgery. A baby spends very little time looking in the distance. Most waking hours are spent looking at objects that are nearby (parents' faces, food, toys etc.) and so we provide contact lenses or spectacles that focus on near objects. This doesn't mean that your baby can't see anything beyond this, but objects in the distance are not as sharp as those that are close. When your baby is older and needs both the distance vision and near vision to be clear, we change the focus of the contact lenses to distance and prescribe a pair of bifocal spectacles to wear over the contact lenses. That may not happen until your child starts school.
Visual development in babies
It is particularly important to stimulate the vision as much as possible in babies with visual or eye conditions. Show your baby brightly coloured toys and black and white shapes to encourage them to follow with their eyes. This will be very slow at first but will gradually become quicker. When glasses or contact lenses are prescribed, it is crucial that your baby wears them as much as possible. It may seem that your baby behaves the same with or without them, but if they are not worn all the time while your baby is awake, their vision may not develop and may get worse if there is no focus for any length of time (more than a few days).
Contact lens types
There are different types of contact lenses and they can be made out of different materials. The lens type will be discussed after your child has been examined. Babies and young children usually adapt to contact lenses faster than adults, and lenses quickly become comfortable for them.
The contact lenses are to be worn during the waking day and removed when your baby sleeps at night. Please note that it is not necessary to remove the lenses while your child naps during the day.
Lens insertion and removal in babies and young children
It can be daunting at first to insert or remove a contact lens from the eyes of a young baby or child, but once you start handling the lenses it becomes easier. You will be taught how to do this in the clinic by an experienced optometrist or optical assistant.
Points to remember:
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Almost all parents are scared of hurting their child’s eyes and may find it difficult to deal with the lenses at first. With time, you will become more confident. Always make sure that your nails are short and smooth when dealing with your baby's contact lenses.
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Wash and dry your hands before touching the eyes or lenses. Any soap can be used to wash your hands, as long as it is not highly scented.
- Inserting or removing lenses should not be painful but a baby may cry in the same way that some babies cry when they are bathed.
The instructions for inserting and removing the lenses in older children are different and you or your child will be taught what to do when attending the clinic.
The instructions for inserting and removing the lenses in older children are different and you or your child will be taught what to do when attending the clinic.
Insertion instructions
1. Have someone hold your child, especially their hands. You can wrap an infant in a blanket. It may be easier to remove (and insert) babies’ lenses when they are asleep.
2. Remove the lens from its container and hold it gently across the middle between your right thumb and index finger (left for left-handed people), as shown. There is only one way to hold the lens; it cannot be easily turned inside out nor can it be upside-down.
3. Using your left thumb, pull up the top lid. It is important to place your thumb as near to the lashes as possible and in order to do so you may need to start with your thumb over the whole eye. Make sure that the eyelid is dry and if necessary, hold the lid through a clean tissue.
Place the edge of the lens under the top lid and using your forefinger gently push the rest of the lens up under the lid until it sits on the eye.
4. Pull down the bottom lid and make sure the lens is in place
The lens will move to the correct position in the eye unless it has folded, in which case it must be removed and replaced. Only soft lenses can fold. A folded lens may be uncomfortable, and your baby may try to rub it out. Any lenses can slip underneath the top lid and disappear from view.
Please note that the lens will not do any damage to your child’s eye if it remains there for some time, even overnight.
It is important to remember that a lens cannot get lost behind the eye and will usually move back into place after a length of time.
If a second lens is inserted into the eye by accident, it will not do any harm, and the first lens will usually fall out.
If you accidentally drop the lens, clean the lens and rinse it with saline (see lens cleaning section) before putting it into your baby's eye. If your child continues to look uncomfortable after a few minutes, or if they won’t stop rubbing their eye, remove the lens, check it, rinse it with saline and then reinsert it.
Removal instructions
1. Have someone hold your child, especially their hands, or swaddle them in a blanket.
2. Place one thumb over the top lid and hold the lid at the very edge on the eyelashes, as if you were inserting the lens. Try to make sure that the lid is pressed gently onto the eye so that the lens cannot slip underneath the top lid.
3. Place the other thumb at the edge of the lower lid and pull it down, making sure that the lid is turned towards the eye - you should not be able to see the inside of the lid
4. Gently press on the edge of the lens that should now be visible and move your thumbs together to scoop the lens out. Turning the lids slightly clockwise or anti-clockwise at the same time helps to remove it. You can touch the lens with your thumbs and put a little bit of pressure on to the eye and the lens will pop out.
Infants contact lens insertion and removal video
video transcript
Contact lens insertion
When inserting your child’s contact lens, remove the lens from its container and hold it gently across the middle, between your thumb and index finger.
Using your thumb, pull up the top lid. It is important to place your thumb as near to the lashes as possible.
Make sure that the eyelid is dry.
Place the edge of the lens under the top lid and, using your forefinger, gently push the rest of the lens up under the lid until it sits on the eye.
Pull down the bottom lid and make sure the lens is in place.
Contact lens removal
When removing your child’s contact lens, place one thumb over the top lid and hold the lid at the very edge on the eyelashes, as if you were inserting the lens.
Try to make sure that the lid is pressed gently onto the eye, so that the lens cannot slip underneath the top lid.
Place the other thumb at the edge of the lower lid and pull it down. Making sure that the lid is turned towards the eye.
Gently press on the edge of the lens, that should now be visible, and move your thumbs together to scoop the lens out.
Turning the lid slightly clockwise, or anti-clockwise, at the same time helps to remove it.
Lens cleaning and disinfection
Cleaning contact lenses is extremely important. If the lenses are not cleaned properly, infection can occur, which can be dangerous to the health of your child’s eyes.
The lenses are usually cleaned and disinfected overnight. You will be supplied with the necessary cleaning solutions by the hospital for a short length of time but if you run out between visits you should purchase additional supplies from a local optician, pharmacist, supermarket, or online.
Please note if you have been given different instructions on cleaning or different solutions by the clinician in clinic, please follow these instructions.
Lens cleaning instructions
- Place the lens on the palm of your hand.
- Put one or two drops of the cleaning solution (Ote Cleaner) onto the lens and rub the lens with your forefinger for about 20 seconds.
- Rinse the cleaning solution off with the saline.
- Fill the case with disinfecting solution (Opti-free Replenish) and place the lens in the case.
- Repeat for the other lens, if two lenses are worn. Always make sure that you keep the right and left lenses separate, as they will not necessarily be the same.
- Screw on the lids of the case and leave overnight or for at least four hours.
Points to remember:
Always clean and disinfect the lenses every time they are removed (although it is not necessary if they are only removed for a few minutes) and change the solution in the case every time the lenses are worn.
Eye infections can occur from not cleaning your contact lens case properly. Once you have put the lenses in your child’s eyes, empty the solution from the case, rinse it with saline solution or Opti-Free Replenish and allow it to air dry upside down on a clean tissue with the lids off. This is because bacteria do not survive as well in dry conditions compared to wet environments. You should also replace your contact lens case every month.
If the lenses are not used for several days or weeks, it is recommended to replace the disinfecting solution every two weeks and clean the lenses as described before inserting them.
Additional information
Visits to the hospital
In the early stages, your child is likely to have frequent hospital appointments. At these appointments, you may need to see several people so please be prepared to spend a few hours at the hospital. The contact lenses that your child needs may not be in stock, so the aim of the first visit is to check the eyes and to take measurements for the lenses.
At the next appointment, the lenses will be given to you, and you will be taught how to insert, remove and clean them. The follow up appointment may be anything between one week and three months later depending on the type of lenses and the age of your child.
Golden rules of contact lens wear
- If at any time an eye looks red, watery, sticky, half-closed or just "not right", the lens must be removed. Remember: if in doubt, leave the lenses out. There is a danger of sight loss if the lens is left in.
- If you see anything unusual or anything that appears to have changed in your child’s eyes, let us know immediately and if necessary, make an appointment to be seen earlier.
- Where possible, remove contact lenses first before seeking medical advice.
- Always ask any questions you have and be sure you understand the answers. If you don’t understand, ask again - we don't mind.
Frequently asked questions
What should I do if my child is having a problem with their contact lens?
If your child’s eyes are red or sticky, or if the eye does not open properly, you must remove the lens. If the eye does not appear to improve after a few hours, contact your local eye casualty. It is still best to remove the lens yourself before seeking medical advice, but do not reinsert it without checking with the hospital first. If a baby who normally wears contact lenses in both eyes develops a problem in one eye, remove both lenses.
If your baby’s lenses need to be removed for more than a couple of days, ensure that back-up spectacles are worn. This is important, as your baby’s sight stops developing when they aren’t wearing contact lenses or spectacles, and the vision can get worse if left for too long.
Babies often rub their eyes when they are tired or if their eyes are irritated. Where possible, distract your baby’s attention by playing with them or handing them a toy. Try not to make too big a deal of stopping them from rubbing their eyes, or they will soon learn how to attract attention. If the lenses are frequently rubbed out, it may be a sign that they are no longer fitting your child properly. You should discuss the problem at your next contact lens appointment or if necessary, seen.
If at any time your child’s eyes look uncomfortable, don't insert the lenses. The lenses should also not be worn when your child is unwell.
Which are better – spectacles or contact lenses?
Many parents are worried that if their baby cannot have implants or if they change from contact lenses to glasses, their vision will be poor. In fact, for people who have had cataracts removed, vision with strong glasses is better than with contact lenses or intraocular lenses. This is because everything appears magnified and bigger objects are easier to see. That is why many children (and adults) prefer to wear their glasses for school or work instead of contact lenses. However, with spectacles, the area that they see (their field of vision) is reduced, which can cause difficulty in some cases.
In a few cases where it is not possible for parents to remove the lenses, or contact lens wear is becoming difficult, we will discuss changing to spectacles full time. Your child’s vision whilst wearing spectacles will develop just as well as in contact lenses and some families find that they are much happier with this. Many children change to spectacles for several months or years. It is not a final decision: you can always ask to change back into lenses later, provided there is no danger to the health of your child’s eyes.
What is the advice when swimming and flying?
Lenses absorb whatever liquid they are kept in or whatever liquid splashes on them. It is advisable to remove the lenses when you are bathing your baby and before swimming to avoid any irritation or infection. After swimming, leave the lenses out for at least two hours. Prescription swimming goggles can be made for older children but the cost for these is not covered by the NHS.
It is advisable to remove contact lenses before flying as Aircraft cabins are usually very dry.
What are the potential contact lens wear problems?
Although a contact lens is made of a plastic that is compatible with the eye, it is still a foreign material to the eye therefore it can cause problems for some eyes. It does this in two ways; first by increasing the risk of infection and second, by reducing the amount of oxygen that normally reaches the cornea. The lack of oxygen is at its worst when the eyes are closed, which is why it is important to remove the lenses at night.
You must keep your appointments at the hospital. If you are unable to attend, make another appointment so that we can check for any sign of problems before they become serious.
In an emergency, or if you have urgent questions, please phone the hospital on 020 7253 3411 ext 4569 between 9am and 4.30pm Monday-Friday.
If your baby needs to be seen urgently at night or weekends, please go to the Moorfields Accident & Emergency department for adults in City Road or call the main switchboard on 020 7253 3411 and ask for A&E, or if closer your local eye casualty.
For any queries about your contact lenses please contact the Contact Lens Orders Department on:
Phone: 020 7566 2100, Monday-Friday 9am-5pm.
Review: April 2028