Although common, giving up contact lens wear during allergy season is often unnecessary. Judicious use of specific ocular medications, as well as switching to other types of contact lenses for limited periods during times of heightened allergic symptoms, or perhaps permanently, may allow continued wearing of contacts. Here are a few tips I would recommend to assist your allergy patients who would like to stay in their contacts:
   1.  Instruct patients to avoid specific antigens. Avoid pollen by wearing wrap-around and closely-fitted sunglasses. Drive with windows closed and the air-conditioner on, and use only high-grade filters for the home A/C system. Reduce pet dander, which is highly allergenic, by keeping pets out of the bedroom and off the bed. Avoid early-in-the-day outdoor activities when pollen levels are highest, and leave the lawn mowing to someone else.
   2.  Dilute and flush those antigens. Use frequent lens lubricants or in-eye lubricant-cleaners. Wash hands and face and shampoo hair more frequently. Reduce exposure to dust mites by more frequent laundering of bed linens at high temperatures.
   3.  The "daily double." Wear only daily disposable lenses during allergy season if at all possible, and steer clear of extended wear too during periods of high antigen exposures.
   4.  Modify lens care. For those who cannot use dailies, emphasize rubbing of lenses prior to disinfection to decrease antigen load and consider switching to hydrogen peroxide systems.
   5.  Avoid eye-rubbing to reduce the mechanical release of inflammatory mediators. Use cold compresses for itching.
   6. Allergy Mantra: "OTCs are not for me!" Most allergy sufferers are likely to overuse OTCs and with vasoconstrictors may wind up with "rebound hyperemia." Prescription medications used judiciously, on a "bid" basis, before and after lens wear, are typically much better.
   7. And what about Meds? The early spring is the right time to start allergy medications, even before severe symptoms strike. For most lens wearers, a combination antihistaminic-mast cell mediator topical eye drop is useful throughout prime allergy months. For severe allergies topical steroids can be added, if necessary, but use only the "soft-steroid" loteprednol products and limit their use to short periods, relying on the combo agents for regular allergy control. OTC oral agents may concurrently be prescribed to further control allergic symptoms, but may lead to greater dryness complaints.
Joel A. Silbert, OD,FAAO, Dipl.
Professor of Optometry
Director, Cornea & Specialty Contact Lens Services
The Eye Institute
Pennsylvania College of Optometry @ Salus University
Philadelphia, PA

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