Contact lens compliance has been discussed for many years without significant change to the percentage of wearers with poor compliance. One of the first papers discussing this was by Collins et al. in 1986. There are many steps and significant barriers to being compliant, many patients have poor recall of advice and compliance education is not always carried out. This article discusses the reasons why compliance matters, factors that influence and the consequences of poor compliance. Poor compliance can cause discomfort and poor vision, and discomfort and poor vision are linked to contact lens drop-out. We summarise the main risk factors in contact lens-related corneal infection and discuss the resulting vision loss and impact on quality of life from contact lens-related microbial keratitis. There seems to be a lack of patient awareness of the risks of water and contact lens-related Acanthamoeba keratitis. We discuss the mixed messaging around the risk of water exposure delivered by global contact lens advocacy groups and contact lens industry marketing material. The final part of the review article discusses what practitioners can do to improve the awareness of risks in contact lens wearers, especially around exposure of water to contact lenses, through using ‘no water’ stickers that have proved effective in a recent study. We also discuss tailored communication tips and suggest a behavioural economics framework to help with contact lens safety conversations between the eye care practitioner and the contact lens wearer.