contact lens care and compliance

Autumn Allergies and Patient Comfort

BY MICHAEL A. WARD, MMSC, FAAO

Seasonal allergies can occur in any season, depending on local environmental conditions. Ocular discomfort is a significant component of seasonal allergy symptoms, which may include sneezing; coughing and postnasal drip; itchy eyes, nose, and throat; and dark circles under eyes.

Hay fever (allergic rhinitis) is frequently caused by pollens. Ragweed is the dominant fall allergy trigger, which causes our immune system to attack the allergen with antibodies, leading to the release of histamines and other inflammatory mediators.

Pollen counts are highest in atmospheres of higher heat, higher humidity, and higher carbon dioxide concentrations. As carbon dioxide concentrations increase, so do the number of pollens and other allergens in our environment. Trees contribute most of the allergens in spring, with flowers, grasses, weeds, and molds following into the fall.

Of all allergy sufferers in the United States, approximately 75 percent are allergic to ragweed, half are allergic to grasses, and 10 percent are allergic to trees. In the southeastern United States, pollens seem to be ever present as the seasons blend together. Molds (fungi that grow in filaments and reproduce by forming spores), dust mites, and animal dander can also cause allergic reactions.

Advice for Allergy Sufferers

Here is some general allergy advice to offer your patients.

• Keep humidity below 50 percent to inhibit mold growth.
• Keep windows closed; high efficiency air filters and electrostatic air cleaners can remove pollen and dust to improve air quality in central air conditioning systems. Replace filters regularly.
• Wear a mask if working outdoors during high pollen count conditions.
• Shower immediately after outdoor exposure to remove pollens from clothes, hair, and skin.
• Wear goggles or close-fitting sunglasses when outside.
• Washing face and hands often with cold water can relieve symptoms. Cold compresses also help to relieve ocular itching.

Contact Lens Care

Here are specific recommendations for contact lens patients.

• Instruct patients to rub and thoroughly rinse their lenses upon removal to decrease the accumulation of debris and contaminants on lens surfaces.
• Change to preservative-free peroxide disinfection systems (e.g. Clear Care [CIBA Vision], Oxy-sept [Abbott Medical Optics, AMO]) if MPS sensitivity is suspected.
• Shorten the replacement interval for soft contact lenses. Consider single-use lenses, which allow wearers to throw away the contact lenses — along with the allergens — daily.

Eye Drops and Medications

Frequent use of low-viscosity, preservative-free artificial tears such as Refresh Plus (Allergan) or Blink (AMO) help to dilute and rinse out irritants. OTC medications such as Zaditor (Novartis), Alaway (Bausch & Lomb) or Similasan Allergy Eye Relief may help relieve symptoms (not to be used over contact lenses).

Systemic antihistamines can help alleviate symptoms, but may lead to ocular dryness. Patients should use topical decongestants sparingly to avoid vascular rebound.

Mast cell stabilizers are helpful if prescribed proactively before symptoms occur. Combination drops such as olopatadine HCl ophthalmic solution 0.1%/0.2% (Patanol/Pataday, Alcon) and epinastine HCl ophthalmic solution 0.05% (Elestat, Inspire Pharmaceuticals/Allergan) offer allergy symptom relief by combining immediate antihistaminic relief with the prolonged effect of mast cell stabilizers. CLS

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