Review of Optometry
PRESENTS
Practice Pearl of the Week
 
Volume 1, Number 24
October 11, 2010
 

Welcome to Review of Optometry's Practice Pearl of the Week series. Optometrist Paul Karpecki will provide you invaluable clinical information and management strategies for a host of ocular conditions—from dry eye and corneal infection to retinal artery occlusion and neuro-ophthalmic disease.

Should patients who suffer from significant allergies suspend contact lens wear?
 

Many times, doctors have difficulty deciding whether a patient who is suffering from allergic conjunctivitis should remove his or her contact lenses for a period of time. But usually, the correct answer to this question is right in front of our eyes—simply evert the upper lid and take a look.

If the upper tarsal plate shows hyperemia, edema or papillae, a short contact lens hiatus of about one to two weeks is likely warranted. It may also be beneficial to start these patients on a corticosteroid q.i.d., such as loteprednol, for one week then b.i.d. for another week as well as an allergy drop, such as Bepreve (beptoastine besilate 1.5%, ISTA), Elestat (epinastine HCl 0.05%, Allergan), Patanol (olopatadine hydrochloride 0.1%, Alcon) or OTC ketotifen. These allergy drops can be used when starting corticosteroids or after the initial course of corticosteroids, depending on symptom severity.

The key indicator is upper eyelid involvement. If hyperemia, edema or papillae are highly visible, a recess from contact lens wear during treatment is a reasonable recommendation. Once the patient returns to contact lenses a week later, for example, use of a corticosteroid or allergy drop b.i.d. (1gtt five minutes before contact lens insertion and 1gtt immediately after contact lens removal) will facilitate an easy transition back into his or her lenses.


"The important thing is to learn a lesson every time you lose." – John McEnroe


 
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