Managing Ocular Allergy in
Contact Lens Wearers

By Robert Campbell, M.D. & Patrick Caroline, C.O.T., F.A.A.O.
SEPT. 1997

Ocular allergy is characterized by itching, mild to moderate redness, conjunctival swelling (chemosis) and watery or ropy discharge. Fortunately, itching is not common in other types of ocular inflammation, so its presence is an important clue in the diagnosis of ocular allergy.

Ocular allergy is classified into five different types of allergic conjunctivitis: allergic rhinoconjunctivitis (hay fever), atopic kerato- conjunctivitis, contact allergy, vernal keratoconjunctivitis and GPC.

TAMING CHRONIC HAY FEVER

This month's case involves a 28-year-old man with an eight-year history of allergic rhinoconjunctivitis. He wears quarterly replacement soft contact lenses to correct �3.75D of myopia OU. He uses a preservative-free hydrogen peroxide system for nightly lens disinfection, with enzyme cleaning twice a week.

His ocular symptoms, which were bilateral and symmetric, included a decrease in lens tolerance secondary to red, itchy, watery eyes (worse during hay fever season), as well as sneezing and rhinorrhea. Slit lamp examination revealed diffuse moderate conjunctival injection with mild chemosis OU (Figs. 1&2). His corneas were clear and visual acuity was stable at 20/20 OU. We easily diagnosed allergic rhinoconjunctivitis and recommended that the patient use an over-the-counter ocular anti- histamine as needed and wear his contact lenses as tolerated.

TREATMENT OPTIONS

Hay fever affects 10 to 20 percent of the U.S. population, so it's no surprise that contact lens wearers frequently manifest the classic signs and symptoms. Identifying and limiting the environmental allergen (pollen from grasses and weeds, molds, dust and animal dander) is the first line of defense. Cold compresses may help decrease redness and relieve some of the symptoms. Frequent use of preservative-free artificial tears or eye washes can help dilute and wash away the environmental allergens.

Pharmacologic treatment (Table 1) is often trial-and-error because there are numerous OTC and prescription drops available but few controlled studies on the efficacy of the various therapies. Corticosteroids are usually the last treatment of choice when all other forms of therapy are ineffective.

Although there is no medical reason to discontinue contact lens wear, patient tolerance will dictate the duration. We usually suggest that soft lens wearers who suffer from ocular allergies limit wearing time while symptomatic. More frequent lens replacement may be a valuable adjunct to pharmacologic treatment. For patients who wear reusable lenses, we suggest nightly hydrogen peroxide disinfection and frequent enzyme cleaning. RGP wearers should limit their wearing time during acute stages and use enzymatic cleaners frequently. CLS

Dr. Campbell is medical director of the Park Nicollet Contact Lens Clinic & Research Center, Minnetonka, Minn. Patrick Caroline is an assistant professor of optometry at Pacific University, Forest Grove, Ore., and director of contact lens research at Oregon Health Sciences University in Portland.