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 help.
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 treatment.
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.