Contact Lens Care & Compliance
Advice for Symptomatic Lens Wearers During Allergy Season
By Michael A. Ward, MMSc, FAAO
Trees are spring's first large scale producers of buds, flowers, and pollens. Grasses, molds, and weeds follow as the seasons advance. It is the pollens that affect our lens wearers. They are both physical (scratchy irritation) and immunologic (hay fever or allergic rhinitis) irritants, affecting roughly 10 percent to 20 percent of the population, with even greater percentages in the warmer and more humid climes.
As carbon dioxide concentrations increase, so do the number of pollens and other allergens. Regrettably, atmospheric CO2 levels are expected to double again over the next 50 years.
A significant physical irritant in the southern United States is the pine pollen, a bi-lobed vesiculate pollen grain with a roughsurfaced body measuring 50µm to 75µm (roughly equal to the thickness of the corneal epithelium). It is the greatest tree-generated physical irritant and feels like aerated sand to our lens wearers. Allergic rhinitis with associated allergic conjunctivitis is the main immunologic consequence to seasonal tree pollens. Expectedly, contact lens wear can be challenging in this environment.
Advice for Lens Wearers
Physical Barriers Wear goggles or close-to-the-face sunglasses with form-fitted foam when outdoors. Keep residence and automobile windows closed.
Air Cleaners High efficiency air filters and electrostatic air cleaners can remove pollen and dust, thereby improving air quality in central air conditioning systems. Be sure to replace filters regularly as directed.
Eye Drops Frequent use of low-viscosity, preservative-free artificial tears will help to dilute and rinse out tear film irritants. In-eye contact lens cleaners such as Blink-n-Clean (Abbott Medical Optics) or Clerz Plus (Alcon) can also be helpful.
Pharmaceuticals Systemic antihistamines can help alleviate allergic symptoms but are associated with ocular dryness. Instruct patients to use topical decongestants sparingly to avoid vascular rebound. Mast cell stabilizers (e.g. cromolyn) are helpful if used proactively before symptoms occur. Combination drops such as Elestat (Inspire Pharmaceuticals), Optivar (Meda Pharmaceuticals), Pataday/Patanol (Alcon), Zaditor (Novartis), and Alaway (Bausch + Lomb) seem to offer the greatest relief of allergic symptoms by combining the immediate antihistaminic relief with the prolonged effect of mast cell stabilizers.
Lens Care Products Ignore “No Rub” labeling. Instruct patients to rub and rinse their lenses upon removal to decrease accumulated debris from the lens surfaces. If a solution-related hypersensitivity or toxicity is suspected, change to peroxide disinfection to eliminate possible preservative sensitivities. Ideally switch to single-use lenses during high pollen season if the prescription allows.
Other Helpful Hints
Washing face and hands often with cold water can be very effective in relieving symptoms. Cold compresses help to relieve ocular itching (try putting ice cubes in a wet wash cloth). Avoid wearing contact lenses under severe conditions. Enjoy the season and its kaleidoscope of colors. CLS
For references, please visit www.clspectrum.com/references.asp and click on document #186.
Mr. Ward is an instructor in ophthalmology at Emory University School of Medicine and Director, Emory Contact Lens Service. He is also a consultant to AMO and B+L. You can reach him at firstname.lastname@example.org.