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- The Immunology of Allergic Conjunctivitis
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Fitting contact lenses for patients with allergies can pose substantial challenges, especially trying to balance patient comfort with quality of vision. This article suggests guidelines to help with this sometimes difficult process.
Reactions to allergy season vary, and patients with allergies tend to have more contact lensinduced irritation than others. These patients can be significantly affected regardless of whether they wear rigid gas-permeable or soft lenses. The manifestations of allergic conjunctivitis vary from hyperemia to conjunctival chemosis to giant papillary reaction on the eyelids. The prevalence of allergic conjunctivitis can be as high as 40% in the general population, and the condition can lead to contact lens dropout in many patients.1
Ways to help patients with allergies maintain their contact lens wear can include instructing them regarding proper lens care, changing the contact lens modality, adding topical eye drops to the patient’s care regimen, or some combination of these actions.
PROPER LENS CARE
It is important to discuss with your optician proper ways to teach contact lens management. Patients may need instruction for rubbing/rinsing/storing or disposing of lenses. Many patients like to use no-rub contact lens solution formulations; however, studies have shown the rub-and-rinse method to provide the highest level of disinfection.2 Hydrogen peroxide-based cleaning systems are highly recommended for patients who are prone to sensitivity to preservatives in multipurpose solutions or who have allergies.3
Similar to multipurpose solutions, hydrogen peroxide systems can break up protein and lipid bonds to remove trapped debris, but hydrogen peroxide contact lens solutions have the advantage that they can better penetrate microbial biofilms.4
Daily disposable contacts are a good alternative for patients who are prone to ocular allergy because they come in singleuse preservative-free cases. Daily disposables are beneficial in that they eliminate any concerns with the preservatives in multipurpose solutions, protein deposits on lenses, and patient noncompliance with lens and case care.5 Frequent replacement helps avoid buildup on lenses, and it also eliminates the need for cleaning solutions, which in some patients can cause sensitivity reactions. In one study, 67% of patients with allergies experienced improved comfort with daily disposable contact lenses, compared with only 18% of patients using a fresh pair of their habitual reusable lenses.4
TOPICAL EYE DROPS
At times, the patient’s signs and symptoms of allergies persist despite changing to a hydrogen peroxide-based solution or switching to daily disposables. In these cases, it is beneficial to consider adding a topical antihistamine eye drop. Topical antihistamines are available with either once-daily (olopatadine HCl 0.2% [Pataday; Alcon]) or twice-daily (bepotastine besilate 1.5% [Bepreve; Bausch + Lomb]) dosing regimens. All such topical antihistamines help decrease papillary reactions, conjunctival hyperemia, and other symptoms associated with allergic conjunctivitis. 6 These drops must be administered when patients are not wearing their contacts.
Artificial tears for rewetting contact lenses can also help to decrease symptoms of allergic conjunctivitis and allow patients to increase their contact lens wear time.7
Contact lens dropout is increasing among patients who are prone to ocular allergy.8 By taking steps such as changing solutions or lens replacement schedules or adding topical eye drops, many patients with ocular allergies can continue to wear contacts lenses comfortably.
- Kumar P, Elston R, Black D, et al. Allergic rhinoconjunctivitis and contact lens intolerance. CLAO J. 2009;17(1):31-34.
- Zhu H, Bandara MB, Vijay AK, et al. Importance of rub and rinse in use of multipurpose contact lens solution. Optom Vis Sci. 2011;88(8):967-972.
- Hughes R, Kilvington S. Comparison of hydrogen peroxide contact lens disinfection systems and solutions against Acanthamoeba polyphaga. Antimicrob Agents Chemother. 2001;45(7):2038-2043.
- Hayes VY, Schnider C, Veys J. An evaluation of 1-day disposable contact lens wear in a population of allergy sufferers. Cont Lens Anterior Eye. 2003;26(2):85-93.
- Lemp MA. Contact lenses and allergy. Curr Opin Allergy Clin Immunol. 2008;8(5):457-460.
- Bielory L, Lien KW, Bigelsen S. Efficacy and tolerability of newer antihistamines in the treatment of allergic conjunctivitis. Drugs. 2005;65(2):215-228.
- Subbaraman LN, Bayer S, Glasier MA, et al. Rewetting drops containing surface active agents improve the clinical performance of silicone hydrogel contact lenses. Optom Vis Sci. 2006;83(3):143-151.
- Richdale K, Sinnott LT, Skadahl E, Nichols JJ. Frequency of and factors associated with contact lens dissatisfaction and discontinuation. Cornea. 2007;26(2):168-174.
Birva K. Shah, OD
• Associate optometrist at Eye Specialists Center, Chicago Ridge, Illinois
• Clinical associate of medicine, University of Chicago Hospital
• Financial disclosure: none acknowledged