therapeutic topics
The Effects of Travel On Contact Lens Wear
BY JULIE A. SCHORNACK, OD, MED, FAAO

Travel at any time of the year brings with it different environments, potentially different medications and a variety of circumstances that could affect contact lens comfort and performance. This month I will examine issues that arise during travel and vacations and how these issues might alter successful contact lens wear.

Dealing with Motion Sickness

Patients who struggle with motion sickness when traveling may choose from several preparations commercially available over-the-counter to combat the uncomfortable effects of this problem. Motion sickness is thought to result from a mismatch between visual stimuli and the inner-ear vestibular system that controls balance. Patients may experience this type of mismatch in sensory input when riding in a car, boat, amusement park ride or swing.

Typically, drugs that alleviate motion sickness symptoms are antihistamines aimed at calming inner-ear sensory activity. Examples of drugs in this category include cyclizine (Marezine), diphenhydramine (Benadryl), dimenhydrinate (Dramamine) and meclizine (Bonine). Scopolamine (the Transderm Scop) acts as an anticholinergic to diminish symptoms of motion sickness.

The most common systemic side effect associated with these preparations is drowsiness, although additional ocular side effects that could alter contact lens wear may occur. Patients who take these motion sickness preparations may experience dry eye, which could result in decreased lens wearing time and generalized symptoms of discomfort. Using an artificial tear supplement could help combat this side effect.

These medications can also have a mydriatic effect that increases light sensitivity. For patients who suffer from this effect, provide specific directions about the importance of wearing sunglasses. Larger pupils and concurrent contact lens use may also cause symptoms of flare and glare.

Some patients may also experience minor to moderate problems with near vision because many motion sickness medications can cause accommodative difficulties. Some patients have needed a low plus power at near to compensate for this side effect.

Skin-Protecting Agents

Other travel and vacation issues that may arise for lens wearers are associated with sunscreens and insect repellants. A widely circulated urban legend claims that getting sunscreen preparations in the eye can cause temporary blindness. Because many available sunscreens contain a waterproofing ingredient, it comes as no surprise that getting these products in your eyes is highly irritating. Accidental ocular exposure to waterproof sunscreen products can cause significant conjunctival hyperemia and subsequent toxic keratitis. Gross contamination of any contact lenses that are worn during accidental ocular exposure often require disposal of the lenses. Treat these patients consistent with the way you would treat other types of toxic keratitis patients, including with ocular lubricants, topical antibiotics and cycloplegia depending on the amount of corneal involvement.

Ingredients found in many insect repellents are also caustic to ocular surfaces and may contain the same waterproofing components that are present in sunscreen. Caution all patients to use these products with care.

Dr. Schornack is the assistant dean of Clinical Education and serves in the Cornea and Contact Lens Service at the Southern California College of Optometry.