Management of Contact Lens Wear in Patients With Ocular Allergy
In order to effectively manage the patient who desires to wear contact lenses, though an ocular allergy sufferer, it is important to remember these useful guidelines.
Avoid or minimize contact lens wear during periods of active seasonal allergic disease. Patients with a history of ocular allergy, including atopy, have a higher incidence of contact-lens-related discomfort. This is true for both rigid and newer soft silicone and high-permeability lenses.
Furloughing patients from contact lens wear during flare-ups of ocular allergy is the safest way to avoid complications associated with lens and allergy interactions on the tear film and ocular surface. Should these prove difficult due to patient visual needs, for example, those with keratoconus or high myopia, effective cleaning of the lens to minimize biofilm build-up is recommended. In those patients whose visual needs can be satisfied with soft contact lenses, the use of daily disposable lenses is likely to minimize this problem. Although there is evidence that certain lenses tend to exhibit less deposit formation than others, individual responses are quite variable.[8•]
Most build-up will occur within overnight wear, particularly with extended wear of contact lenses. In patients experiencing ocular allergy, the extended wear of contact lenses is considered a contraindication.
It should also be noted that the concomitant use of topical antiallergic medication with contact lenses is generally frowned upon. Many of these formulations, particularly those containing the preservative, benzalconium chloride, can be irritating to the ocular surface.[9](this is the best succinct, contemporary review of the role of preservatives and other ingredients of ophthalmic formulations and their possible side effects. There is nothing better since). For this reason, the concomitant use of these agents with contact lens wear is thought to have the potential to aggravate damage to the ocular surface. For this reason, the use of systemic antiallergic medications should mitigate this risk. Systemic antihistamines, however, have a drying effect and can decrease tear secretion in addition to their soporific effects.[10] (still the current best source for review of this topic). Newer formulations with less tendency for drowsiness and drying make their use in contact lens wearers more attractive.[11]
The interactions between topical medications, the lenses and the ocular surface are not yet well understood and their utility is under current investigation.[1••] In this regard, however, a recent study[12•] has investigated patient perceptions of the use of topical olopatadine 0.2% in a large (330 patients) multicenter study of patients with active ocular allergic signs and symptoms. These patients had previously been treated with 0.1% olopatadine drops. Patients were more satisfied with the 0.2% formulation than their prior 0.1% drops. Of interest is a subset of patients who were wearing contact lenses. Eighty-eight percent of the 48 patients in this group believed they could wear their lenses as desired and no safety findings were reported in this 28-day study.
In summary, the use of contact lenses in periods of active allergic disease of the ocular surface should be avoided when possible. In other circumstances, meticulous cleaning of the lenses with effective disinfecting regimens is essential. Daily disposable lenses offer the best alternative to no lens wear although may not be feasible in all cases, for example, keratoconus.
A special case of the interaction between the contact lens and ocular allergic mechanisms is that of giant papillary conjunctivitis (contact-lens-induced papillary conjunctivitis). There is a separate chapter on this topic in this issue.
Curr Opin Allergy Clin Immunol. 2008;8(5):457-460. © 2008 Lippincott Williams & Wilkins
Cite this: Contact Lenses and Allergy - Medscape - Oct 01, 2008.
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