What is the treatment for an allergic reaction to glasses coatings?

Treatment of Allergic Reactions to Glasses Coatings

For allergic reactions to eyeglass coatings or frames, immediately identify and eliminate the causative allergen by replacing the frames, then apply tacrolimus 0.1% ointment once daily to the external eyelids and lid margins for 2-4 weeks, which achieves an 89% response rate. 1

Immediate Management Steps

1. Allergen Identification and Removal

• Review all eyeglass materials including frame composition, coatings, and contact points with skin 1
• Suspect eyeglass-related contact dermatitis when periorbital involvement affects areas where the frame touches the face 1
• Common allergens in eyeglass materials include nickel (even in varnish on frames), palladium, titanium alloys, plasticizers, UV stabilizers, and various plastic components 2
• Frame replacement with hypoallergenic materials is often the only definitive solution 2

2. First-Line Topical Treatment

• Apply tacrolimus 0.1% ointment once daily to external eyelids and lid margins for 2-4 weeks 1
• For children aged 2-17 years, start with tacrolimus 0.03% ointment and increase to 0.1% only following ophthalmology advice 1
• Use preservative-free ocular lubricants to soothe the affected area and provide symptomatic relief 1
• Implement lid hygiene measures including eyelid warming devices or commercially available lid wipes to clean eyelid margins 1

3. Adjunctive Symptomatic Relief

• Add antihistamine eye drops (olopatadine, ketotifen, or azelastine) for mild-to-moderate cases with significant itching 1
• Apply cold compresses for additional symptomatic relief 3
• Use refrigerated preservative-free artificial tears to dilute allergens and inflammatory mediators 3, 4

Critical Pitfalls to Avoid

• Never use preservative-containing formulations as they can cause additional allergic contact dermatitis 1
• Avoid topical corticosteroids as primary treatment - they provide only transient resolution and do not prevent recurrences 1, 2
• If corticosteroids are used, they require ophthalmology monitoring for glaucoma and cataracts 1
• Do not assume silver or gold-appearing frames are nickel-free - varnish coatings may contain nickel 2
• Plastic frames contain combinations of materials (zyl, propionate, nylon, carbon, polycarbonate) making exact allergen identification difficult 2

Mandatory Referral Criteria

• Refer to ophthalmology immediately for all children under 7 years due to limited ability to communicate symptoms and risk of interference with normal ocular development 1
• Refer moderate-to-severe cases not responding to initial treatment 1
• Refer any case requiring topical corticosteroids for monitoring of potential side effects 1
• Refer all patients using tacrolimus ointment for ophthalmology review within 4 weeks 1
• Consider allergist referral for patch testing with contact allergens and analysis of softened scrapings from frames 2

Follow-Up Protocol

• Reassess at 4 weeks for patients on tacrolimus ointment during ophthalmology review 1
• Monitor regularly if topical corticosteroids are used, checking for signs of skin atrophy, glaucoma, and cataracts 1
• Verify complete allergen avoidance by confirming frame replacement with hypoallergenic materials 1, 2

Special Considerations

• Patch (epicutaneous) testing on contact allergens with analysis of frame scrapings is valuable for definitive allergen identification 2
• Hypoallergenic eyeglass frames are available on the market and should be recommended after allergic reactions 2
• The most common allergens in eyeglass materials are plasticizers, UV stabilizers, and nickel 2
• Even titanium frames may contain palladium, which can cause allergic contact dermatitis 2