It is generally possible for people with diabetes to wear contact lenses, but this requires a heightened level of commitment to safety and eye care. The systemic effects of diabetes on the body, particularly the eyes, introduce specific risks that must be carefully managed before and during contact lens wear. Understanding how diabetes changes the eye’s environment is the first step in determining if contacts are a safe and viable option.
How Diabetes Affects Corneal Health and Tear Production
Chronic high blood glucose levels can significantly alter the physiology of the anterior eye, creating an environment less tolerant of contact lenses. Diabetes often leads to changes in the tear film, resulting in decreased tear secretion and an unstable tear film. This contributes to dry eye syndrome, a common complication for diabetic patients.
The cornea itself is highly susceptible to damage due to diabetic neuropathy, which is nerve damage that reduces corneal sensitivity. This reduced sensation means that minor irritation or injury from a contact lens may go unnoticed for a longer period. Furthermore, the cornea’s epithelial cells, which form the protective outer layer, become more fragile and take longer to heal when blood sugar is poorly controlled.
This combination of poor tear quality and reduced nerve function makes the diabetic eye less resilient to the mechanical stress and metabolic demands of wearing a contact lens. The cornea is also at risk of corneal edema, or swelling, because diabetes can affect the function of the endothelial cells responsible for regulating corneal hydration.
Heightened Risks Associated With Contact Lens Wear
Wearing contact lenses introduces additional risks to an already vulnerable diabetic eye. The most significant concern is the increased susceptibility to microbial keratitis, a severe infection of the cornea. This risk is amplified because diabetes can impair the immune response and delay the healing of the corneal surface.
Microscopic abrasions or epithelial defects caused by a contact lens can quickly become entry points for bacteria, fungi, or yeast, leading to serious complications. Since corneal sensation is often reduced, a diabetic patient may not feel the early warning signs of pain or discomfort. This lack of early detection allows an infection or injury to progress to a more serious stage before treatment is sought.
Corneal erosions, where the outer layer of the cornea detaches, are more likely to occur in eyes with high blood sugar and can be exacerbated by contact lens wear. Studies have shown that while the overall rate of complications with daily wear soft lenses may be only slightly higher for diabetics, the consequences of those complications can be more severe due to delayed wound healing.
Essential Safety Protocols for Diabetics Wearing Contacts
Successful and safe contact lens wear depends on strict adherence to specialized management protocols. Maintaining stable blood glucose is paramount, as an elevated hemoglobin A1C (HbA1C) level correlates with an increased risk of dry eye syndrome and other ocular surface problems. Eye care professionals often use the HbA1C level, with values around 10 or higher potentially ruling out contact lens use, as a factor in determining suitability.
A rigorous hygiene routine is the most critical safety measure, starting with washing and drying hands with a lint-free towel before touching the lenses. Lenses must be thoroughly cleaned, rinsed, and disinfected with fresh solution every time they are removed; tap water should never be used on the lenses or case. The lens case must also be replaced every few months to prevent bacterial buildup.
Eye care professionals frequently recommend daily disposable contact lenses for diabetic patients because they eliminate the need for cleaning and storage, significantly reducing the risk of contamination. Extended-wear lenses, which are worn overnight, are strongly discouraged due to the increase in infection risk associated with sleeping in any lens.
Regular, specialized eye examinations are a non-negotiable protocol for diabetics, typically required at least once a year. These exams involve dilation to check for diabetic retinopathy and include a detailed assessment of the anterior segment of the eye for subtle signs of corneal damage or infection. The eye doctor must evaluate the cornea’s health, tear film quality, and the patient’s overall glycemic control before prescribing or continuing contact lens use.