Whitney Fleming, a writer based in Grand Rapids, Michigan, initially felt no alarm when she woke to discover her left eye was sore and irritated. Fleming had worn soft contact lenses since her adolescence, meticulously cleaning them, replacing them bi-weekly with new pairs, and consistently removing them before sleep.
However, as the discomfort steadily worsened and none of the prescribed treatments proved effective, Fleming grew distressed. She was unable to drive, and light exposure became unbearable. The relentless pain spread to her face and neck, ultimately resulting in the loss of vision in her left eye. She remembers, “I was truly beginning to disengage from life, consumed by so much pain.”
Ultimately, three weeks later, a corneal specialist diagnosed Fleming with Acanthamoeba keratitis, a condition caused when Acanthamoeba—a prevalent parasite found in tap water, dirt, soil, and various non-sterile water sources such as pools or lakes—infects the cornea, the eye’s transparent outer layer. While the precise method of infection remains unknown, Fleming’s doctor indicated the most probable cause was a daily habit shared by millions: wearing contact lenses while showering.
The risks of wearing your contacts to shower
Dr. Thomas Steinemann, a spokesperson for the American Academy of Ophthalmology and a professor of ophthalmology at Case Western Reserve University in Cleveland, states, “We advise individuals that contact lenses and water are incompatible.”
Approximately 50% of Acanthamoeba keratitis cases affect contact lens wearers, according to Dr. Saba Al-Hashimi, an assistant professor of ophthalmology in the cornea division at UCLA’s Stein Eye Institute. While the amoeba is largely harmless if swallowed or entering the ears, he explains that “if it gets underneath your contact lens, then it can find a way to become an opportunistic infection.”
This occurs for several reasons. Primarily, the parasite, which strongly adheres to contact lenses, becomes lodged between the lens and the cornea, he explains. The cornea’s surface, often marked by minuscule abrasions from lens friction, provides entry points for the amoeba, allowing it to burrow deeper with prolonged exposure.
Steinemann emphasizes, “Once established, the deeper it penetrates, the more challenging it becomes to eliminate.”
An under-recognized disease
Despite years of contact lens use, Fleming was unaware of the recommendation to avoid showering—or swimming or hot tub use—while wearing them. Steinemann observes, “Many individuals don’t grasp that any water contact poses a risk. They often comment, ‘I never knew this; why wasn’t I informed years ago?’”
While Acanthamoeba keratitis has traditionally been considered rare, with only about 1 to 33 cases annually in the U.S., Steinemann states, “I think people are gradually realizing that a lot of these infections fly under the radar.” The disease is frequently misdiagnosed as other conditions, which can impede timely and correct treatment.
Al-Hashimi notes, “Frequently, it’s mistaken for herpes, and patients are given steroid drops, which only worsen the infection.” He adds that even with a correct diagnosis, “it takes at least three to four months to eradicate the infection. However, in some instances, the parasite endures even after a year of treatment. It’s an exceptionally difficult pathogen to eliminate.” Fleming stresses that if you are exhibiting symptoms of Acanthamoeba keratitis—such as eye pain, excessive tearing or redness, and sensitivity to light—it is essential to advocate for yourself during your appointment. She notes, “Many optometrists and ophthalmologists have never encountered a live case.” Steinemann, who trains ophthalmology residents, emphasizes that eye-care professionals should be prepared to identify it. “The sooner we consider it, when we see a patient with a red, painful eye, the sooner we can intervene and get it treated.”
How to mitigate your risk
Acanthamoeba is not the sole waterborne organism capable of causing significant damage if it adheres to a contact lens surface. Steinemann identifies Pseudomonas aeruginosa as “probably the most common and most feared,” capable of inducing a severe corneal infection. While all types of contact lenses carry some risk, Steinemann advises his soft lens patients to consider daily disposable lenses. This approach not only lowers the risk of contamination—as a fresh pair is used daily—but also simplifies discarding lenses if they are inadvertently exposed to water. He explains, “It’s not as good as not exposing it to the water, but if you’re wearing a single-use daily lens, let that be the last wear.”
Al-Hashimi suggests that investing in prescription goggles for swimming can be beneficial, allowing you to forgo contacts entirely; these goggles could even be worn in the shower. Furthermore, he adds, if you are a candidate for refractive surgery like LASIK, “that’s one way to get rid of your contact lenses and get to live your life the way you want to live it.”
“A roll of the dice”
Nearly a decade later, Fleming has gradually regained vision in her left eye, although a scar persists over her pupil. Beyond the direct consequences of her infection, she also developed a stomach ulcer from taking steroids during that period, cracked four teeth from pain-induced grinding, and reports that her mental health deteriorated both during and after her illness.
She states, “Had I comprehended the potential consequences, I would have been far more cautious. It’s a gamble you absolutely want to avoid.”
Regarding showering with contacts, Steinemann emphasizes that prevention is paramount. He comments, “Many individuals are either unaware of this risk or might have heard of it but dismiss it, thinking, ‘It’s only a brief shower, no big deal.’ However, if we can prevent the issue entirely, that’s the best approach.”