What to do in an emergency

What to do first

  • Don’t panic.
  • Think. Is it really an emergency?
  • Is it a lens problem or an eye problem? Remove the lens to find out if the problems persists.
  • You won’t lose anything by pausing for 30 seconds.
General discomfort is not usually an emergency and might be caused by a damaged or contaminated lens, changing to a new solution, the side effects of medication, sinus trouble or hay fever. Most serious problems will result in a more acute red eye.


An eye infection

If an eye is acutely painful, comparable to toothache, it is quite probably something more serious than just conjunctivitis. It is, possibly, a corneal infection – especially if there are other symptoms such as redness, swelling, sensitivity to light and persistent watering. The following is particularly important if you wear lenses overnight for extended wear.

What to do

  • The lens should be removed and help sought without delay.
  • Never go to bed with a really red or painful eye.
  • Waiting for an appointment may waste valuable time.

You should be seen by an ophthalmologist, for example at the casualty department of a hospital. He (or she) is in the best position to assess the gravity or otherwise of the condition and if necessary to begin the proper treatment, which is not that usually given for a simple problem like conjunctivitis. It is a good thing to know where such help is available before it is needed so be aware of the location of your nearest eye hospital.

If it is a corneal infection, the longer you delay, the more chance there is of causing a long term visual problem. There are no marks for heroics if it hurts!

Violent stinging or burning

Stinging, burning or a similar adverse reaction to solutions is one of the most common causes of red and sore eyes. Have you put the cleaning solution instead of the wetting solution in your eyes? Have you changed anything in your normal routine or had to buy an unfamiliar brand and not looked at the instructions? Also think whether you might have had a trace on your hands of anything chemical or something used in food preparation such as pepper or chilies.

What to do

Remove the lenses and rinse the eyes extremely thoroughly. Ideally, use one of the proprietary 0.9% saline solutions which will be sterile and neutral. Failing this, simply use large quantities of tap water. The most painful reactions occur with the hydrogen peroxide preparations which have not been neutralized properly. Apart from copious rinsing, try comfort or rewetting drops as their smoother more viscous qualities should make the eyes more comfortable. It also helps to keep the eye closed. If the symptoms persist you should seek medical help.

Visual problems

Here it is important to decide if it is the contact lens or the eye. Check the obvious such as whether the lenses are in the correct eye or you haven’t used an old lens by mistake. What happens if you put on spectacles? Migraine sufferers often have visual disturbances ranging from flashes of light to a temporary but complete loss of vision. Computer use sometimes produces similar effects.

What to do

If you have confirmed a sudden loss of vision and that it is not a contact lens problem, then you should have a proper diagnosis made as a matter of urgency. The most common symptoms are ‘flashes and floaters’ (the flashes are less zig-zag in appearance than with migraine). These could be either a disturbance in the gel within the eye (more common and not necessarily serious) or a tear in the retina – much more serious and must be seen as a matter of urgency. We can usually arrange an immediate referral to an ophthalmologist or this could be made by your general practitioner. If it is out of hours, use the emergency addresses. If you are very short-sighted, stress this plus the nature of your symptoms.

Foreign body

This is the most common cause of sudden, sharp discomfort, particularly amongst hard lens wearers. It is usually caused by a piece of dust or grit behind the lens.

What to do

Generally, nothing. The foreign body is nearly always washed away by the tears and the discomfort should disappear. It may leave a very superficial scratch which will heal quite rapidly and need no treatment.

If the eye remains painful, remove, clean and re-insert the lens. If it is still painful, a foreign body may be trapped on the surface of the eye or it may have created a much deeper scratch or abrasion which requires some minor first aid. Remove the lens, telephone us or use one of the emergency addresses at the end.


A lens, or part of a lens, trapped under the top lid.

It will not be stuck there forever; it can’t get into the back of your head; it is not dangerous; and will often re-appear on its own.

What to do

Try tilting your head back, feeling through the top lid and pushing towards the outer corner of the eye where you may be able to see the lens. Alternatively, try washing it out using an eye bath, preferably filled with saline solution. If this doesn’t work, telephone and we will try to fit you in for an appointment straight away or ‘talk you down’. If it happens at night and there is no discomfort, it can nearly always wait till the morning. If it is painful, then use one of the emergency addresses at the end.

Be sure the lens you are trying to remove hasn’t come out of the eye – if the vision is normal, it is still there on the cornea. Trying to remove a non-existent contact lens will cause far more discomfort!

A haemorrhage on the white of the eye

This is the worst looking but least serious eye problem to have. It is the eye equivalent of a nose bleed but because the blood is trapped it spreads around the white of the eye and may take a few days to resolve. These haemorrhages may be the result of bruising the eye during the night or from lens handling. Sometimes they occur spontaneously and are often worse if you are taking aspirin or other anti-coagulent medication.

What to do

Nothing – if you are sure this is the problem, there is no pain and the vision is completely normal. There is no actual treatment but if in doubt get it checked either by us or by someone local.

In central London a 24 hour casualty service is available from the following NHS hospitals:

Emergency treatment is available from the following private clinics.

Many other local hospitals, including the following, also have excellent day time emergency eye clinics: