We conducted a historical cohort study of 2,433 cosmetic contact lens wearers (1,055 conventional [non-disposable] daily wear lens users, 905 disposable extended wear lens users, and 473 conventional extended wear lens users) in order to estimate the rates of occurrence of complications and symptoms among disposable extended wear contact lens users and compare these rates with those for conventional soft daily wear users and conventional soft extended wear users. Data were abstracted from the office records of eight eye care practitioners for the period February 1987 through April 1989. The prevalence of all complications for disposable extended wear lens users was not significantly different from the prevalence for conventional daily wear lens users but was significantly lower than the prevalence for conventional extended wear lens users. The incidence of ulcers among disposable extended wear lens users did not differ significantly from the incidence found with conventional extended wear, but was significantly higher than the rate for conventional daily wear. Disposable extended wear lenses, in contrast to conventional extended wear lenses, may be more strongly associated with benign peripheral infiltrates than with the more serious central ulcers. Disposable extended wear lens users reported symptoms less frequently at routine scheduled visits than both conventional daily wear and conventional extended wear users and had a lower rate of unscheduled visits for complications and symptoms.