20 Dispensing & Patient Education Practice Questions & Answers

1. 1. A rigid gas permeable lens ordered for a patient arrives from the laboratory on the morning of the dispensing visit. What should be done with that lens before it is placed on the patient's eye?

   • A.Dispense it on the strength of the laboratory's certificate and verify it at the follow-up.
   • B.Verify its parameters and surface quality against the written order, then dispense it.✓ Answer
   • C.Compare it with the diagnostic lens used at the fitting and dispense it if the two match.
   • D.Insert it and judge the parameters from how the lens centres and moves on the eye.

   Verification confirms that the lens received is the lens ordered: power, base curve, diameter, edge form and surface quality are checked at the bench before the lens ever touches the eye, because a mislabelled or defective lens dispensed on trust produces poor vision or corneal insult and is only discovered after the patient has worn it.

   Source: ABO-NCLE Contact Lens Registry Exam content outline, Dispensing; Bennett & Henry, Clinical Manual of Contact Lenses (lens verification before dispensing)Report a problem with this question

2. 2. A first-time soft lens wearer has watched the fitter demonstrate insertion and removal and says she understands. What must happen before she leaves the office with her lenses?

   • A.She watches the instructional video a second time and takes home the printed handout as well.
   • B.She books the follow-up visit and is told to practise the handling at home tonight.
   • C.She demonstrates removal only, because the fitter has already inserted the lenses.
   • D.She inserts and removes the lenses herself, unaided, while the fitter observes her.✓ Answer

   Teach-back is the standard at a dispensing visit: understanding is demonstrated, not claimed, so the patient must insert and remove the lenses unaided in front of the fitter, who can then correct technique before the patient is alone at home with a lens she cannot get out.

   Source: ABO-NCLE Contact Lens Registry Exam content outline, Dispensing (handling instruction); American Optometric Association contact lens patient education guidanceReport a problem with this question

3. 3. Which chart entry best documents a contact lens dispensing visit?

   • A.A note recording that the patient was verbally instructed and understood all of the material.
   • B.The parameters of the lenses dispensed, the instruction given, and what the patient demonstrated.✓ Answer
   • C.The care system sold, the fee collected, and the date on which the prescription expires.
   • D.The parameters of the lenses dispensed and the date the next lens supply becomes due.

   The record has to show what left the office and what the patient can actually do, so it names the lens parameters dispensed, the wear and care instruction given, and the handling the patient performed unaided; a bare statement that the patient understood everything records an opinion rather than an observed performance.

   Source: ABO-NCLE Contact Lens Registry Exam content outline, Dispensing (patient education and documentation); Bennett & Henry, Clinical Manual of Contact Lenses (record keeping)Report a problem with this question

4. 4. Why is washing and drying the hands before every insertion and removal taught as the single most important habit a lens wearer keeps?

   • A.It keeps the antibacterial proteins of the tear film from being diluted during handling.
   • B.It rinses off any disinfectant residue that would otherwise sting when the lens is inserted.
   • C.It removes organisms and skin oils from the fingers that would be carried onto the lens.✓ Answer
   • D.It warms the fingertips so that the lens flexes less and settles more comfortably.

   The fingers are the vehicle that carries contamination to the ocular surface: washing with a mild, non-oily soap and drying on a lint-free towel removes bacteria, amoebae and sebum before they reach the lens, which is why hand hygiene does more to prevent microbial keratitis than any other single habit.

   Source: U.S. Food and Drug Administration, Contact Lens Care consumer guidance (hand washing before handling lenses); CDC Healthy Contact Lens Wear and CareReport a problem with this question

5. 5. A wearer holds a soft lens on a fingertip and looks at its profile from the side. Which finding tells her the lens is inside out?

   • A.The engraved markings on the lens read the right way round from the front.
   • B.The lens folds closed on itself when it is squeezed gently near its base.
   • C.The edges turn straight up, so the lens forms a neat bowl on the fingertip.
   • D.The edges flare outward and away, so the lens has a shallow, saucer-shaped profile.✓ Answer

   A right-side-out soft lens has edges that continue the curve upward into a bowl, and it folds cleanly on itself when pinched, while an inverted lens has edges that turn out and away, giving the flatter saucer profile; engraved markings that read correctly also confirm the correct orientation.

   Source: Bennett & Henry, Clinical Manual of Contact Lenses (soft lens handling: inversion checks)Report a problem with this question

6. 6. A soft lens wearer keeps trying to pinch the lens off the centre of the cornea and cannot remove it. Which technique should she be taught?

   • A.Look down, press the lower lid against the lens edge and roll the lens out.
   • B.Look up, set a suction cup on the centre of the lens and lift it straight off.
   • C.Look up, slide the lens down onto the white of the eye, then pinch it off there.✓ Answer
   • D.Look ahead and pull the outer corner of the lids until the lens pops out on its own.

   Pinching a lens while it lies on the cornea traps corneal epithelium between the fingers and abrades it, so the lens is first slid onto the less sensitive scleral conjunctiva, where the two edges can be brought together and the lens lifted away without touching the cornea.

   Source: Bennett & Henry, Clinical Manual of Contact Lenses (soft lens removal technique)Report a problem with this question

7. 7. A rigid lens wearer with lax lids cannot remove her lens with the lid techniques she was taught, and the lens is resting on the sclera. What is the appropriate next step?

   • A.Use a moistened suction removal device applied to the lens surface itself, not to the eye.✓ Answer
   • B.Use a fingernail under the lens edge to lift the lens away from the eye surface.
   • C.Use a cotton-tipped applicator pushed beneath the lens edge to lever the lens off.
   • D.Use the suction device on the cornea next to the lens to break the lens seal first.

   A suction removal device is the reserve technique for exactly this situation, poor lid tone or a lens displaced onto the sclera, and it is moistened and placed on the lens surface only; anything applied to the cornea or levered under the lens edge abrades epithelium and can tear conjunctiva.

   Source: Bennett & Henry, Clinical Manual of Contact Lenses (rigid lens removal; indications for a suction removal device)Report a problem with this question

8. 8. A soft lens wearer telephones convinced that a lens has slipped behind her eye. What should she be told?

   • A.A lens that disappears has usually drained through the tear duct and needs no search.
   • B.A lens behind the eye is flushed out by rinsing the eye under a running tap for a while.
   • C.A lens can slip into the orbit, so she must be seen the same day to have it removed.
   • D.A lens cannot pass behind the eye; instil saline, look down and evert the upper lid.✓ Answer

   The palpebral conjunctiva reflects at the fornix onto the globe and closes the space, so no lens can reach the orbit; a lens that seems to have vanished is almost always folded in the superior fornix, and lubricating the eye, directing gaze away from it and everting the upper lid brings it into view.

   Source: Bennett & Henry, Clinical Manual of Contact Lenses (displaced lens management); conjunctival fornix anatomyReport a problem with this question

9. 9. A wearer fell asleep in soft lenses and one lens now feels dry and stuck to the eye. What should she be told to do?

   • A.Grip the lens at its edge and pull it straight off before the eye dries further.
   • B.Blink hard with the lids squeezed shut until the blinking works the lens free.
   • C.Rinse the eye with warm tap water until the lens loosens enough to be pinched out.
   • D.Instil sterile saline or rewetting drops and wait until the lens moves freely.✓ Answer

   A dehydrated soft lens adheres to the epithelium, and pulling it off takes epithelium with it, so the lens is rehydrated with sterile saline or a rewetting drop and left until it slides on the eye again; tap water is never used because it carries Acanthamoeba and other organisms.

   Source: Bennett & Henry, Clinical Manual of Contact Lenses (adherent or dehydrated lens removal); CDC Healthy Contact Lens Wear and CareReport a problem with this question

10. 10. Which combination of symptoms should a wearer be taught to treat as a reason to remove the lenses, leave them out, and be seen the same day?

    • A.Slight dryness at the end of the day with vision that clears on a hard blink.
    • B.Lens awareness, watering and mild glare during the first week of a new rigid fitting.
    • C.Itching in pollen season with clear vision and a white, comfortable eye all day.
    • D.Redness, sensitivity to light, blurred vision or pain that persists after removal.✓ Answer

    Redness, photophobia, vision change and pain are the classic remove-and-refer signs because they are how microbial keratitis and other sight-threatening events announce themselves, and pain that continues after the lens is out is never ordinary adaptation; discomfort that clears the moment the lens comes off is a different matter.

    Source: American Optometric Association and CDC contact lens wearer guidance (remove-and-refer symptoms: redness, sensitivity to light, vision change, pain)Report a problem with this question

11. 11. A wearer stores her reusable soft lenses overnight in sterile saline because she finds it gentle on her eyes. What is the problem with this?

    • A.Saline is too salty for hydrogel and draws water out of the lens overnight.
    • B.Saline dissolves the surface film and leaves the lens front poorly wettable.
    • C.Saline rinses and stores lenses but has no disinfecting action against organisms.✓ Answer
    • D.Saline disinfects properly only if the lenses have been rubbed with a cleaner beforehand.

    Sterile saline contains no disinfecting agent at all: it is isotonic rinsing and storage fluid, so lenses kept in it overnight sit in a warm, nutrient-bearing bath in which contaminating organisms multiply, and the wearer must use a multipurpose or peroxide system for disinfection.

    Source: U.S. Food and Drug Administration, Contact Lens Solutions consumer guidance (sterile saline is for rinsing and storage, not disinfection)Report a problem with this question

12. 12. A wearer of reusable soft lenses has hazy vision and a gritty feeling late in the day, and the lens surfaces carry a bound deposit the nightly cleaner has not removed. Which product addresses that deposit?

    • A.Rewetting drops, instilled on the eye each time the deposit blurs the vision again.
    • B.Enzymatic cleaner, used as directed alongside the usual disinfection step.✓ Answer
    • C.Sterile saline rinse, run over the lens for longer before it goes into the case.
    • D.Surfactant daily cleaner, rubbed on for longer than the label directs each night.

    Surfactant cleaners lift lipid, mucus and loose debris, but tightly bound protein needs an enzyme to break it down, so an enzymatic product is used as a periodic adjunct; it digests deposit and does not disinfect, which is why the normal disinfection step still has to follow.

    Source: Bennett & Henry, Clinical Manual of Contact Lenses (contact lens care systems: surfactant versus enzymatic cleaners)Report a problem with this question

13. 13. A patient using a three percent hydrogen peroxide system takes a lens from the bottle after a short soak, inserts it, and reports immediate burning. What explains the reaction?

    • A.The peroxide had not been fully neutralised before the lens went on the eye.✓ Answer
    • B.The peroxide bottle had been stored too warm, which raised the solution's acidity.
    • C.The peroxide neutralised too fast and left the lens incompletely disinfected.
    • D.The peroxide had bleached the lens surface and made it abrasive on the cornea.

    Peroxide disinfects because it is cytotoxic, and it is safe on the eye only after the catalytic disc in the supplied case, or the neutralising tablet in a two-step product, has converted it to water and oxygen; cutting the labelled soak short leaves active peroxide on the lens, which stings and burns the epithelium immediately.

    Source: U.S. Food and Drug Administration guidance on hydrogen peroxide contact lens care products (complete neutralization before insertion)Report a problem with this question

14. 14. A soft lens wearer reports burning and redness within minutes of insertion with diffuse punctate staining, and has reacted the same way to two different preserved multipurpose solutions. Which care system should be considered?

    • A.A saline soak overnight with a surfactant cleaner used every morning instead.
    • B.A hydrogen peroxide system, which disinfects the lenses without any chemical preservative.✓ Answer
    • C.A multipurpose solution built on a different large-molecule preservative instead.
    • D.A rigid-lens cleaner used on the soft lenses to strip the preservative residue.

    Burning on insertion with diffuse punctate staining is the picture of a preservative sensitivity, and a peroxide system is the classic answer because it is preservative free and neutralises to water and oxygen, leaving nothing in the hydrogel matrix for the eye to react to.

    Source: U.S. Food and Drug Administration, Contact Lens Solutions consumer guidance; ABO-NCLE Contact Lens Registry Exam content outline, Dispensing (solution sensitivities)Report a problem with this question

15. 15. A wearer says he pours a little fresh solution onto what is already in the case each night so the bottle lasts longer. Why is this unsafe?

    • A.Fresh solution added to used solution becomes too concentrated for the lens material.
    • B.Topping off dilutes the case solution so the lens cannot stay properly hydrated.
    • C.Used solution has spent its disinfecting power, so the lenses are not disinfected.✓ Answer
    • D.Repeated additions warm the case enough to break the preservative down over time.

    A disinfectant is consumed as it kills, so the fluid left in the case after a night's use is spent and already carries organisms and debris; adding a splash of fresh solution dilutes the new dose into an exhausted one, and the case must instead be emptied completely and refilled each time.

    Source: CDC Healthy Contact Lens Wear and Care (do not top off solution; discard and replace solution each time)Report a problem with this question

16. 16. What is the correct routine for the storage case each morning, once the lenses have been taken out of it?

    • A.Wipe it out with a paper tissue and close it until the lenses come out at night.
    • B.Empty it, rub and rinse it out with fresh solution, and stand it open to air-dry face down.✓ Answer
    • C.Empty it, rinse it under hot tap water, and close the caps to keep the dust out.
    • D.Refill it with fresh solution at once so it is ready for the lenses that night.

    The case is the commonest reservoir of contamination in lens wear because organisms build a biofilm on its walls, and that biofilm is disrupted by rubbing and rinsing with fresh solution and then dried out in air; tap water reseeds the case, and closing it damp keeps the biofilm alive until the next night.

    Source: CDC Healthy Contact Lens Wear and Care (clean, rinse with solution, air-dry the case face down; replace it as directed)Report a problem with this question

17. 17. A wearer showers and swims in her soft lenses and rinses the case under the tap. Which specific hazard should she be warned about?

    • A.Allergic conjunctivitis, from the chlorine that is dissolved in swimming pool water.
    • B.Giant papillary conjunctivitis, from protein bound to the lens front surface.
    • C.Corneal neovascularisation, from the lens swelling in the fresh water it absorbs.
    • D.Acanthamoeba keratitis, a water-borne corneal infection that resists treatment.✓ Answer

    Acanthamoeba is a free-living amoeba of tap water, pools, hot tubs and lakes that adheres readily to a hydrogel lens and then invades the cornea; the resulting keratitis is painful, hard to eradicate and can end in corneal transplantation, which is why lenses and cases must never meet water of any kind.

    Source: CDC Healthy Contact Lens Wear and Care (water and Acanthamoeba keratitis risk); FDA contact lens consumer guidanceReport a problem with this question

18. 18. What should a first-time rigid gas permeable wearer be told about adaptation that a first-time soft lens wearer would not be told?

    • A.Comfort returns only if wear is stopped for several days between wearing sessions.
    • B.Comfort improves over an adaptation period, so wearing time is increased gradually.✓ Answer
    • C.Comfort depends on wearing the lenses overnight at first so that the lids stop reacting.
    • D.Comfort is immediate, so a full day of wear is possible from the very first day.

    A rigid lens edge moves under the lid with every blink, so lid sensation, reflex tearing and mild photophobia are expected at first and settle as the lids adapt; wearing time is therefore built up on the schedule the prescriber sets, and missed days set the process back, whereas a soft lens is comfortable almost at once.

    Source: Bennett & Henry, Clinical Manual of Contact Lenses (rigid lens adaptation and wearing time build-up)Report a problem with this question

19. 19. A patient wearing a monthly-replacement silicone hydrogel lens on a daily wear basis asks whether she may now sleep in it, since the lens lasts a month. What is the correct answer?

    • A.Overnight wear depends on the lens being approved and prescribed for it, not on how long it lasts.✓ Answer
    • B.Overnight wear is safe for one or two nights a week in any reusable soft lens material.
    • C.Overnight wear is acceptable in any silicone hydrogel lens, since oxygen passes freely through that material.
    • D.Overnight wear is acceptable in a monthly lens provided it is discarded at the end of the month.

    Replacement interval and wearing modality are independent: how often a lens is thrown away says nothing about whether it may be slept in, which is decided by the lens's own approved labelling and the prescriber's instruction, and sleeping in a lens not approved for it is the largest modifiable risk factor for microbial keratitis.

    Source: U.S. Food and Drug Administration, Contact Lenses (wear schedules and approved overnight wear); CDC Healthy Contact Lens Wear and CareReport a problem with this question

20. 20. In what order should a wearer use hairspray, insert the lenses, and apply eye makeup?

    • A.Lenses in first, then hairspray, then makeup, with the lenses out after makeup removal.
    • B.Hairspray first, then makeup, then the lenses in, with the lenses out before makeup removal.
    • C.Makeup first, then the lenses in, then hairspray, with lenses out after makeup removal.
    • D.Hairspray first, then the lenses in, then makeup, with lenses out before makeup removal.✓ Answer

    Aerosols are applied before the lenses go in so that airborne propellant and resin cannot settle on a lens already on the eye, cosmetics go on afterwards so that particles land on the lids rather than on the lens surface, and the lenses come out before removal so that oily removers and loosened makeup never reach them.

    Source: U.S. Food and Drug Administration, Contact Lenses consumer guidance (cosmetics, aerosols and lens wear)Report a problem with this question

Practice questions based on the ABO-NCLE Contact Lens Registry Exam content domains and standard contact lens references, together with the FTC Contact Lens Rule and FDA device classification. This site is not affiliated with or endorsed by ABO-NCLE. Contact lens fitting is regulated state by state — scope of practice, supervision and licensure requirements vary, so confirm your own state's rules and work under the prescriber's direction. Verify current exam requirements with ABO-NCLE before testing. About the ABO-NCLE exams →