CONTACTS AND ALLERGIES: By BIRVA K. SHAH, O.D.

Written by EyeSpecialistsCenter on . Posted in Uncategorized

 Fitting contact lenses for patients with allergies can pose substantial challenges, especially trying to balance patient comfort with quality of vision.  This article suggests guidelines to help with     this sometimes difficult process.  

  Reactions to allergy season vary, and patients with allergies tend to have more contact lens-induced irritation that others.  These patients can be significantly affected regardless of whether they wear rigid gas-permeable or soft lenses.  The manifestations of allergic conjunctivitis vary from hyperemia to conjunctival chemosis to giant papillary reaction on the eyelids.  The prevalence of allergic conjunctivitis can be as high as 40% in the general population, and the condition can lead to contact lens dropout in many patients.

  Ways to help patients with allergies maintain their contact lens wear can include instructing them regarding proper lens care, changing the contact lens modality, adding topical eye drops to the patient’s care regimen, or some combination of these actions. 

PROPER LENS CARE
  It is important to discuss with your optician proper ways to teach contact lens management.  Patients may need instruction for rubbing/rinsing/storing or disposing of lenses.  Many patients like to use no-rub contact lens solution formulations; however, studies have shown the rub-and-rinse method to provide the highest level of disinfection.  Hydrogen peroxide-based cleaning systems are highly recommended for patients who are prone to sensitivity to preservatives in multipurpose solutions or who have allergies.
  Similar to multipurpose solutions, Hydrogen peroxide systems can break up protein and lipid bonds to remove trapped debris, but hydrogen peroxide contact lens solutions have the advantage that they can better penetrate microbial bioflims.
  Daily disposable contacts are a good alternative for patients who are prone to ocular allergy because they come in single use preservative-free cases.  Daily disposables are beneficial in multipurpose solutions, proteins deposits on lenses, and patient non compliance with lens and case care.  Frequent replacement helps avoid build up on lenses, and it also eliminates the need for cleaning solutions, which in some patients can cause sensitivity reactions.  In one study, 67% of patients with allergies experienced improved comfort with daily disposable contact lenses, compared with only 18% of patients using a fresh pair of their habitual reusable lenses.

TOPICAL EYE DROPS
  At times, the patient’s signs and symptoms of allergies persist despite changing to a hydrogen peroxide-based solution or switching to daily disposables.  In these cases, it is beneficial to consider adding a topical antihistamine eye drop.  Topical antihistamines are available with either once-daily (olopatadine HCI 0.2% [Patadax; Alcon]) or twice-daily (bepotastine besilate 1.5% {Bepreve; Bausch & Lomb]) dosing regimens.  All such topical antihistamines help decrease papillary reactions, conjunctival hyperemia, and other symptoms associated with allergic conjunctivitis.  These drops must be administered when patients are not wearing their contacts. 

Artificial tears for rewetting contact lenses can also help to decrease symptoms of allergic conjunctivitis and allow patients to increase their contact lens wear time.

CONCLUSION
 
Contact lens dropout is increasing among patients who are prone to ocular allergy.  By taking steps such as changing solutions or lens replacement schedules or adding topical eye drops, many patients with ocular allergies can continue to wear contact lenses comfortably.

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