cultivating compliance

Lens Patients and Allergies

BY VISHAKHA THAKRAR, OD, FAAO

In many parts of the country, this allergy season was a miserable one. Every year, contact lens wearers flock to our offices complaining of itchy, watery, red eyes, discharge and lens intolerance. How do we help allergy sufferers remain comfortable in lenses? The answer varies depending on the severity of their allergies.

Treating the Symptoms

Patients with mild acute ocular allergies include those who suffer from seasonal or perennial allergic conjunctivitis. Symptoms can vary greatly and can be exacerbated by lens wear. These patients experience red, itchy eyes, burning, mucous discharge and discomfort while wearing lenses.

Slit lamp exam may reveal bilateral papillae, injection, chemosis and lid swelling. You can relieve symptoms by limiting lens wear, refitting to a daily disposable modality or changing to a hydrogen peroxide system. Cold compresses and artificial tears can also ease symptoms.

Topical therapeutics such as combination mast cell stabilizer/antihistamine drops relieve symptoms relatively quickly while addressing the underlying inflammatory response. Patanol (olopatadine hydrochloride ophthalmic solution 0.1%, Alcon), Zaditor (ketotifen fumarate ophthalmic solution, Novartis), Alaway (ketotifen fumarate ophthalmic solution, Bausch & Lomb), Optivar (azelastine hydrochloride ophthalmic solution 0.05%, Meda Pharmaceuticals, Inc.) and Elestat (epinastine HCl ophthalmic solution 0.05%, Allergan) involve b.i.d. dosing, so work well for contact lens patients. Pataday (olopatadine hydrochloride ophthalmic solution 0.2%, Alcon), another combination drop, offers once-daily dosing and thus may benefit noncompliant patients.

Patients may use antihistamine drops to treat symptoms, however these aren't effective for chronic sufferers. You can treat severe acute cases with Pred Forte (prednisolone acetate, Allergan) or topical cyclosporine A to calm the inflammatory response. In these patients, temporarily discontinue contact lens wear.

Patients with chronic ocular allergies include those who suffer from atopic and vernal keratoconjunctivitis. In mild forms, patients may experience mucous discharge, red itchy eyes, chemosis and lid edema. In more severe cases, patients may experience blurred or decreased vision, pain, photophobia and pseudoptosis. Slit lamp examination may reveal a varying papillary response, corneal vascularization and scarring, injection and chemosis.

Depending on severity, patients may find it difficult to wear lenses. In mild cases, it may be necessary to switch the modality to a daily disposable lens. Mast cell stabilizer/antihistamine drops may be beneficial for these patients.

If symptoms worsen at certain times of year, patients should start medication two weeks before allergies begin to control cell degranulation. For patients who don't respond to combination drops, using a steroid like Alrex (B&L) or Lotemax (B&L) four times a day may provide relief.

Limit Lens Wear

In severe cases, patients should temporarily or permanently cease lens wear. In some cases, GP scleral lenses may be effective in managing atopic patients. Many chronic sufferers require Pred Forte to calm the inflammatory response. Systemic involvement may require anti-IgE treatment and oral anti-inflammatories like prednisone, methotrexate or cyclosporine. During periods of remission, cyclosporine A, a mild steroid and/or a combination drop can help limit the allergic response.

When lens wearers suffer from allergies, utilize a step-wise treatment plan to maintain safe and comfortable lens wear. Nevertheless, in certain cases, we need to limit lens wear to ensure our patients' ocular health. CLS

Dr. Thakrar has a specialty contact lens practice and is a clinical optometrist at the TLC Laser Eye Center in Mississauga, Ontario. She is a graduate of The Ohio State University and completed a residency in cornea and contact Lenses at the New England College of Optometry.