Contact Lens Care & Compliance

Helping Lens Wearers Cope With Seasonal Allergies

BY MICHAEL A. WARD, MMSC, FAAO

Springtime is the fleeting, wonder-filled, seasonal explosion of bright floral colors, singing birds, and life’s renewal. Grasses awaken from their dormancy, trees sprout new growth. Ah, the joys of spring…except for those who have seasonal allergies.

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 as well as itchy eyes, nose, and throat. Pollen counts are highest in atmospheres of higher heat, higher humidity, and higher carbon dioxide concentrations. Trees contribute most of the allergens in spring, with flowers, grasses, weeds, and molds following into the fall.

Advice for Allergy Sufferers

Here is some general allergy advice to offer to your patients:

• Keep room 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 and often.

• 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 help to relieve ocular itching.

Contact Lens Care

Here are specific recommendations for contact lens patients who experience ocular allergies:

• Instruct patients to rub and thoroughly rinse their lenses upon removal (don’t wait until the next day) to decrease the accumulation of debris and contaminants on lens surfaces.

• Change to preservative-free peroxide disinfection systems such as Clear Care (Alcon) or Oxysept (Abbott Medical Optics [AMO]) if you suspect multipurpose solution sensitivity.

• Frequent use of low-viscosity, preservative-free artificial tears such as Refresh Plus (Allergan) or Blink (AMO) help to dilute and rinse out irritants.

• 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.

Pharmaceuticals

Systemic antihistamines and decongestants can help relieve allergic symptoms but are associated with dryness. Instruct patients to use topical decongestants sparingly to avoid inflammatory rebound. Mast cell stabilizers such as cromolyn sodium and lodoxamide (Alomide, Alcon), alcaftadine (Lastacaft, Allergan), bepotastine (Bepreve, Bausch + Lomb), olopatadine (Patanol/Pataday, Alcon), nedocromil (Alocril, Allergan), and ketotifen (Zaditor, Novartis) inhibit histamine release, but are helpful only if used proactively before symptoms occur. Topical antihistamines competitively and reversibly block histamine receptors and relieve itching and redness, but only for a short time. Topical antihistamines do not affect other proinflammatory mediators such as prostaglandins and leukotrienes, which remain uninhibited (Medscape). Topical antihistamines include epinastine (Elestat, Allergan) and azelastine (Optivar, Meda Pharmaceuticals). Topical cyclosporine and steroids may also be helpful in more advanced cases. CLS

For references, please visit www.clspectrum.com/references.asp and click on document #209.

Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service. You can reach him at mward@emory.edu.