contact lens care
Maintaining Comfortable Lens Wear During Pollen Season
BY MICHAEL A. WARD, MMSC, FAAO

As I write this, Atlanta is blossoming with color. Red and pink azaleas, white dogwoods and multicolored tulips and pansies brighten our daylight-savings-time lengthened days. The flora isn't all that's blossoming. Today, our pollen count (number of pollen particles per cubic meter of air) is 512. Pollen counts are categorized as low (zero to 30), moderate (31 to 60), high (61 to 120) and extreme (>120). One day this spring we reached 5,200 particles per cubic meter.

Challenging Lens Wear

Pollen may affect contact lens wearers in multiple ways. It's both a physical and an immunologic irritant. Pollen allergy (hay fever or allergic rhinitis) affects nearly 10 percent of Americans (26 million people), not including those with asthma.

Trees contribute the majority of the pollens in spring, with flowers, grasses and molds to follow. Our greatest physical irritant is pine pollen, a bi-lobed vesiculate pollen grain with a rough surfaced body measuring 50µm to 75µm (roughly equal to the corneal epithelium's thickness). Visualize a gentle breeze moving a yellow cloud of pine pollen that engulfs a contact lens wearer. The particles land in the tear film and instantly create significant foreign body sensation, causing pain, scratchiness and tearing. To add insult to injury (literally), an allergic reaction occurs, releasing inflammatory mediators that cause tearing, itching and chemosis in susceptible individuals.

Tools to Fight the Irritants

We can help allergy sufferers by offering the following strategies to help them continue wearing their contact lenses during this difficult time.

Physical Barriers Wear goggles or sunglasses that fit close to the face when outside. Keep windows closed, including car windows.

Air Cleaners High efficiency air filters can remove pollen and dust to improve air quality in central air conditioning systems. Electrostatic air cleaners also can help. Instruct patients to replace filters regularly as directed.

Eye Drops Frequent use of low-viscosity, preservative-free artificial tears will help to dilute and rinse tear film irritants. In-eye contact lens cleaners such as Blink-N-Clean (Advanced Medical Optics) or Clerz Plus (Alcon) also can help.

Pharmaceuticals Systemic antihistamines can alleviate allergic symptoms, but they also may cause ocular dryness. Use topical decongestants sparingly to avoid a rebound effect. Mast cell stabilizers help if patients use them pro-actively before symptoms occur. Combination drops seem to offer the greatest allergy symptom relief by combining immediate antihistaminic relief with the prolon-
ged effect of mast cell stabilizers.

Lens Care Products Ignore the "no rub" product labeling. Instruct patients to rub and rinse their lenses upon removal to decrease accumulated debris from the lens surfaces. If you suspect a solution-related hypersensitivity or toxicity, change to peroxide disinfection to eliminate possible preservative sensitivities.

Replace Lenses Often Shorten the replacement interval for soft lenses. Consider single-use lenses, which allow wearers to throw away the lenses -- along with the allergens -- daily.

Other Helpful Hints

Instruct patients to wash their face and hands often with cold water. Cold compresses help to relieve ocular itching (try putting ice cubes in a wet wash cloth). Patients should avoid wearing lenses under severe conditions.

Proactively offering allergy advice helps patients comfortably wear their contact lenses and enjoy the season with its kaleidoscope of colors.

Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service.