With the introduction of silicone hydrogel (SiHy) lenses over a decade ago, clinicians have seen both improvements and challenges in contact lens (CL) wear. Regardless of lens design or material, the presence of a CL on the ocular surface induces mechanical complications. Although some of these complications have diminished in frequency and severity with newer generations of SiHy lenses, others persist at previously reported levels. The aim of this review is to provide up-to-date information on mucin balls, superior epithelial arcuate lesions, corneal erosions, CL-induced papillary conjunctivitis, conjunctival epithelial flaps, lid wiper epitheliopathy, and meibomian gland dropout. The conclusions in this review should provide a sound basis for identifying the future areas of research to help minimize mechanically driven adverse events during CL wear with SiHy lenses.