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.
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.