Contact Lens Business
Contact Lens and Allergy
Contact lens patients can be especially sensitive to allergens. Here's how to help.

When a contact lens patient comes into your office with symptoms of an allergic reaction, the first thing you should do is determine whether the contact lenses are part of the problem.

Start by asking whether the irritation only occurs when the patient is wearing the lenses. If the lenses appear to be involved:

• Take a history. Is the problem with one eye or both eyes? Does it start as soon as the lenses are in, or after they've been in for most of the day?
  • If the irritation appears when the lenses are first inserted, a lens care solution may be causing the problem.
  • If the irritation appears after several hours of lens wear, the fit of the lenses (or a defective lens) is more likely to be the culprit.
• Evaluate the fit. Poorly fitting contact lenses (soft or RGP) can cause hypoxia with associated staining of the cornea and injection of the conjunctiva.
• Change elements systematically. If you believe the problem is contact lens-related, change one element at a time so that you can evaluate the results. Change solutions; order new lenses; or refit from scratch. You'll know that you've solved the problem when the symptoms of irritation disappear.
  Likewise, if the patient has giant papillary conjunctivitis, try altering the solutions, lenses or the care and wear regimen. Or, try switching the patient to daily wear disposable lenses. Have the patient use drops as appropriate.

DETERMINING OTHER CAUSES

If the lenses aren't the problem, try to determine the real source of irritation. Conjunctival symptoms are likely to be caused by exposure to pets, chemicals, ocular medications (including contact lens solutions) or environmental allergens, such as pollen from grasses, plants or trees.

Dryness and redness with irritation of the lids are more likely to be caused by medications. If the patient doesn't know the specific source of the problem, questioning may reveal the answer.

Contact lens patients are more sensitive to irritation than the average patient, so it's a good idea to have the patient remove the lenses until the situation improves. In any case, be sure to tell the patient not to rub his eyes. (Rubbing may damage mast cells, causing them to release irritating mediators.)

TREATING THE PROBLEM

If the problem isn't caused by the lenses, treatment can be similar to treating a patient who doesn't wear contacts:

• In the case of hay fever-type signs and symptoms, dilution of the allergen with tear substitutes and cool compresses may solve the problem.
• Massive edema of the conjunctiva usually clears before drops are instituted, and thus usually requires no treatment.
• A short course of steroids (topical and/or systemic) may have immediate, but temporary results. Generally, steroids should be avoided because of their well known side-effects and the potential for patient abuse.
• Other medications (such as sodium cromolyn, nedocromil or ketotifen) have preventive and therapeutic actions; they must be used on a continuing basis. They can be used while the patient is wearing lenses. (Hopefully, the preservatives won't add to the problem.)
• If the patient's symptoms include associated rhinitis and sinusitis, you may have to supplement drops with systemic agents. (These can cause drying, however, which may cause further contact lens problems.) Convey your concerns about sinusitis to any other doctor who is treating the patient.

COMFORT IS THE KEY

Because contact lens wearers are more sensitive to irritation, they're often very grateful when you help them find relief. So, give them a thorough evaluation to determine the precise cause of their symptoms, and recommend a treatment regimen that addresses their special needs as contact lens wearers.

Frank J. Weinstock, M.D., FACS, practices at Canton Ophthalmology Associates in Canton, Ohio. He's also a professor of ophthalmology at the Northeastern Ohio Universities College of Medicine in Canton.