SOOTHING SEASONAL ALLERGIES
By PHYLLIS L. RAKOW, COMT, NCLE-AC, FCLSA(H), Princeton, N.J.
With the allergy season in full bloom, eyecare
practices are once again besieged by patients complaining of red, itchy, watery
eyes. Hardest hit are contact lens wearers, whose discomfort often is
exacerbated by the adverse effects of common allergy remedies.
Oral antihistamines can cause dry eye, forcing
patients to abandon their lenses. In addition, patients can unwittingly damage
their soft contact lenses by instilling incompatible eye drops while wearing
their lenses, causing increased irritation or lens yellowing.
What can you do to help these patients find
relief and keep wearing their contact lenses?
Laying the groundwork
Ideally, contact lens patients who know they have
ocular allergies should see their doctors about starting preventative mast-cell
blocking or combination mast-cell blocking/antihistamine eye drops several weeks
before the allergy season starts. Unfortunately, most patients wait until
they're completely miserable to make an appointment. Luckily, they're not beyond
You should begin every allergy evaluation with a
thorough patient history, making special note of symptoms, known allergies,
duration of the allergy season and any prescription or over-the-counter oral
medications or eye drops the patient is using. As the primary information
gatherer, you may uncover factors that can help the treating practitioner
understand the extent of a patient's allergies and prescribe the best available
Keeping 2-week or extended wear patients in
contact lenses during allergy season may require some creative thinking.
Some eyecare practitioners switch patients to
1-day disposable lenses for the duration of the allergy season. Wearing fresh
lenses every day can eliminate problems caused by excessive mucus buildup and
can prevent hypersensivitiy to chemicals in lens care systems. Patients with
antihistamine-related dry eye may benefit from lenses with improved water
retention and slow evaporation rates, such as Acuvue Advance, CooperVision
Proclear and Extreme H2O.
For your part, you can reinforce the importance
of keeping contact lenses clean. Advise patients who normally use
"no-rub" cleaners to rub and rinse their lenses to remove mucus or
traces of pollen before storing them in disinfecting solution.
If allergies cause increased sensitivity to
disinfecting solutions, advise patients to rinse their lenses with a
preservative-free saline solution before applying them in the morning. Patients
with supersensitive eyes may benefit from a hydrogen peroxide care system that
neutralizes into preservative-free saline overnight.
Remind patients to use rewetting drops liberally
throughout the day to prevent antihistamine-induced dryness and to flush pollen
from their lenses. Extremely sensitive patients may need to use
preservative-free rewetting drops or drops with a "disappearing
preservative." Also, wearing sunglasses can help prevent pollen from
adhering to the lenses.
Finally, promote a "hands-off" policy.
Contact lens wearers must resist the urge to rub their eyes when their allergies
act up. They could displace their contact lenses, but more importantly, they
could inadvertently transfer microorganisms into their eyes from their unwashed
hands, further irritating their already inflamed eyes.
Your patients don't have to suffer with seasonal
allergies. A little extra attention to contact lens maintenance can keep your
patients seeing clearly all year.
Contact Lens Spectrum, Issue: May 2004