Soft Contact Lens Solution Allergies

November 15, 2015

Reproduced with permission from Dr. Kent Schauer. This article represents the opinions and professional experience of Dr. Schauer as shared with his patients. Please consult your eye care professional when considering any changes to your contact lens solutions, and discuss any concerns you have about preservatives or about preservative free solutions with them.

History: 

There are basically three main soft lens multipurpose solutions: 1) Alcon Optifree 2) Bausch and Lomb Renu and 3) AMO Complete. The store brands are usually one of these under a different label. I first recognized an allergic response to Optifree on July 9, 1994. I then began seeing about one solution allergy per month. All of those patients had been using Optifree for approximately five years and suddenly (one day) began to notice their lenses were drying more, getting more buildup, and not lasting as long. I attributed this to mild symptomology to the minute quantity of chemical (preservative) in these solutions. Microscopic findings were equally subtle. At first, I recommended those patients switch to one and then the other multipurpose solution only to see them all return within six months with the same complaints. Sometime in 1996, I began putting all solution allergy patients on AOSept (a preservative-free hydrogen peroxide system), which is now Clear Care. They universally reported resolution of their symptomology. I have seen the incidence of multipurpose solution allergy increase linearly over the years and today would estimate that 99+ % of all of my soft lens wearers have become allergic to all of the preserved multipurpose solutions, as well as most preserved salines and rewetting drops. Now I am more and more frequently, seeing patients who have been doing well for some time, present with the same symptomology of lenses drying and getting buildup and not lasting as long. I can almost always determine that the recurrence of their symptomology corresponded to their using a preserved saline to rinse their lenses and/or a preserved rewetting drop to rewet their lenses. I call this “polluting your preservative-free system.” 

As of the date of this paper, Alcon will no longer produce Unisol 4, which most of you use to rinse with. As a result, I anticipate that pollution of your preservative-free system, which by now should be Clear Care, will again become more common. 

YOUR CLEAR CARE OR OTHER HYDROGEN PEROXIDE STERILIZING SYSTEM IS PRESERVATIVE-FREE. YOU CAN NEVER BECOME ALLERGIC TO IT. DO NOT POLLUTE IT WITH PRESERVED SALINE OR PRESERVED REWETTING DROPS. 

1. Since Unisol 4 has recently been discontinued you can switch to Purilens. All of the sensitive eyes saline you see on the shelves in standard bottles are preserved and will pollute your preservative-free Clear Care system. 

2. Use only preservative-free rewetting drops. Preservative-free drops come only one way—in daily dose units.  I recommend Tears Naturale Free or Refresh Plus, which can be found in almost any drugstore. Use the drops freely since the vial must be discarded daily. Again, preserved rewetting drops in standard bottles will pollute your preservative-free Clear-Care system. 

3. If you are using Clear Care and not rinsing in the morning and your lenses sting on insertion then a) you are “cranking” the lid too tight. Just turn it with the tip of one finger until it stops. Or b) your disc in the bottom of the Clear Care cup has worn out. I recommend one new cup for each bottle of Clear Care. 

4. If you are in less than 1% of patients I see who have not yet become allergic to the multipurpose solutions, the following is the best way for you to monitor solution allergies. First, do not rinse a new pair of lenses with your storage solution. Disposable lenses come packaged in preservative-free saline. Simply take them out and put them on. Pay attention to how your lenses feel the first day compared to the second day. If you can say that they feel better the first day, you have become allergic to your multipurpose solution or solutions. That has been the appropriate question to detect multipurpose allergies for all of these years. If you are accustomed to rinsing your new lenses with preserved multipurpose solution the difference will not be so obvious. 

5. Occasionally, I see solution allergies where the symptomology is not so subtle. You know something is seriously wrong. In these cases, I will see significant microscopic findings to correspond with the symptomology. These conditions are called superficial punctate keratitis and even more severe, infiltrative keratitis. The fact that the signs and symptoms are much more severe can almost always be traced to the prolonged use of lenses, the vicious cycle of rewetting more frequently with preserved rewetting drops, or possibly the variability of individual allergic response. If I have diagnosed you with either superficial punctate keratitis or infiltrative keratitis, I will insist on discontinuation of contact lens wear for some period of time and treat you with topical steroids. In most cases, you will be able to resume lens wear in one week with your new preservative-free system, Clear Care and preservative-free saline and rewetting drops. 

Kent Schauer, O.D.