pediatric and teen cl care

Lens Complications: Allergy and Antibiotic Medications

BY JEFFREY J. WALLINE, OD, PHD, & MARJORIE J. RAH, OD, PHD

Fortunately, contact lens complications are rare, but we must be ready to treat pediatric patients appropriately when they occur. Two of the most commonly used types of medications to treat side effects of pediatric contact lens wearers are anti-allergy and antimicrobial agents.

Most eyecare practitioners have treated a young child who has red eyes from allergies or ocular infection. Typically, pediatric lens wearers will be well within the approved age range for most anti-allergy or antibiotic medications, and adult dosages are appropriate to prescribe. However, extremely young children with medically necessary contact lenses may provide greater challenges because fewer medications are approved for these ages.

You may wish to prescribe Alrex (loteprednol etabonate ophthalmic suspension 0.2%, Bausch & Lomb) for children who present with itching eyes as well as conjunctival injection and chemosis. However, Alrex is approved only for patients 12 years and older, so you must consider other options. There are also several antibiotic formulations that do not have pediatric approval, such as Polysporin (polymyxin B sulfate and bacitracin), Neosporin and bacitracin.

When no option exists with the appropriate age approval, then prescribe medications to treat the underlying cause appropriately, following appropriate off-label guidelines. However, it is in the patient's and practitioner's best interest to prescribe medications that have FDA approval for the patient's age. CLS

Dr. Walline is an assistant professor at The Ohio State University College of Optometry, where he conducts studies of pediatric contact lens wear. He is also a consultant or advisor and has received research funds from Paragon and Vistakon. Dr. Rah is a staff optometrist at the Massachusetts Eye and Ear Infirmary Contact Lens Service where she specializes in medically necessary and other advanced contact lens designs.