|Bepreve from Bausch + Lomb is prescribed for itching associated with allergic conjunctivis.|
How to treat seasonal allergy symptoms in the contact lens wearer.
Contact lens designs and materials continue to evolve and improve, resulting in increasing numbers of people wearing contact lenses. However, some people have to forego their preferred form of vision correction when seasonal allergies spring up.
Some form of allergy affects approximately 15% to 30% of the world population, and ocular symptoms are present in 40% to 80% of those patients. Seasonal allergic conjunctivitis (SAC) and perennial allergic conjunctivitis (PAC) by far represent the most frequently encountered allergic conjuctivitis and are typically treated with a combination of palliative, systemic and topical pharmacological treatments.
TREATING CL WEARERS
The same classes of medication are used to treat those with allergies regardless of whether the person wears contact lenses or not. Olopatadine (Patanol, Pataday and Pazeo””all from Alcon Labs) is generally considered the gold standard treatment for itching associated with allergic conjunctivitis. The big difference in treating contact lens wearers is the frequency of dosing. Most contact lens wearers prefer BID dosing so that they do not need to remove their lenses during the course of the day.
Even though the recommended treatment may be QID dosing, I will often prescribe from QID to BID to TID dosing depending on the wearing time. For example, if patients wear their lenses from 8am until 6pm, I can treat them TID without having them remove their lenses during the day. If, however, they wear their lenses from 8am until 11pm and refuse to remove their lenses during the day, BID dosing is all we do. Of course, if they are being treated for a severe allergic response, they will either have to stop wearing contact lenses and wear glasses so that they can achieve the appropriate dosage or remove their lenses twice during the day so that the drops can be applied without the lenses on the eye.
ADVICE FOR THE ALLERGIC
Avoidance of allergens (tree and weed pollens, grasses and outdoor molds) for sensitized individuals is the simplest approach to preventing allergic conjunctivitis. But that’s easier said than done. The use of daily disposable contact lenses (see “Single (Use) and Loving It” on page 16) as a barrier to allergens during exacerbations is also an effective treatment for the contact lens wearer. This, along with cold compresses to reduce itching and artificial tears to dilute and wash away allergens, are effective measures to manage mild early stage allergic conjunctivitis. While this approach may also improve symptoms associated with PAC since degranulation of mast cells in PAC recruits eosinophils, a more aggressive therapeutic approach may be required.
The two most effective pharmaceutical agents to treat allergic conjunctivitis are dual-acting antihistamine/mast cell stabilizers and steroids. Newer dual-acting agents, such as Pazeo from Alcon or Bepreve from Bausch + Lomb, are extremely effective in controlling itching in both early and late stage responses. They combine histamine receptor antagonists and mast cell stabilizers.
Steroids, such as Lotemax from Bausch + Lomb and Durezol from Alcon, are used to suppress late-phase production of inflammatory mediators such as basophils, eosinophils, T-cells and neutrophils that are responsible for more severe ocular reactions and corneal damage associated with more serious allergic conditions, such as vernal keratoconjunctivitis and atopic keratoconjunctivitis, and therefore are generally not used for early stage reactions.
As eyecare practitioners we now have significant tools to treat allergic conjunctivitis and provide improved quality of life to our patients. OO
Kenneth A. Lebow, OD, FAAO, is in private practice in Virginia Beach, VA, and is on the Optometric Office editorial advisory board.
WHERE TO FIND IT:
Alcon Laboratories, Inc.
Bausch + Lomb