What treatment options are available for allergic reactions to eyeglass lenses additives?

Treatment of Allergic Reactions to Eyeglass Lens Additives

The primary treatment is immediate removal of the offending eyeglass frames or lenses, followed by topical corticosteroids for 1-2 weeks to resolve the contact dermatitis, with frame replacement using hypoallergenic materials as the definitive solution. 1

Immediate Management

First Step: Allergen Removal

• Discontinue wearing the current eyeglass frames immediately to eliminate ongoing allergen exposure, as this is the only definitive solution to prevent recurrences 1
• Identify the specific allergen through patch testing with analysis of softened scrapings from the frames, as eyeglass frames contain multiple potential allergens including nickel, palladium, plasticizers, UV stabilizers, and various plastic components 1

Acute Dermatitis Treatment

• Apply topical corticosteroids to affected skin areas (retroauricular region, nasal bridge, temporal areas where frames contact skin) for transient clinical resolution, though this does not prevent recurrence without frame replacement 1
• The duration should be limited to 1-2 weeks to minimize systemic absorption and side effects 2

Frame Replacement Strategy

Material Selection

• Switch to hypoallergenic eyeglass frames made from materials less likely to cause allergic reactions 1
• Avoid frames that appear silver or gold but may contain nickel, as varnish applied to frames can be a source of nickel even when the underlying metal differs 1
• Consider titanium frames, but verify they do not contain palladium, which can also cause allergic contact dermatitis 1
• Be cautious with plastic frames (zyl, propionate, nylon, carbon, polycarbonate, optyl, polyamide) as they contain combinations of materials making exact composition difficult to determine 1

Diagnostic Confirmation

Patch Testing

• Perform epicutaneous patch testing on contact allergens with analysis of softened scrapings from the patient's frames to identify the specific causative agent 1
• The most common allergens identified are plasticizers, UV stabilizers, and nickel 1
• This testing is valuable for guiding future frame selection and preventing recurrence 1

Important Clinical Considerations

Common Pitfalls

• Do not rely solely on topical corticosteroids as they provide only temporary relief without addressing the underlying allergen exposure 1
• Recognize that contact dermatitis from eyeglass frames should be suspected in patients with retroauricular dermatitis or lesions at points of skin contact with frames 1
• Distinguish between allergic contact dermatitis and irritant contact dermatitis, as management differs 1

If Ocular Symptoms Present

• If the patient develops concurrent allergic conjunctivitis from lens additives or frame materials, treat with dual-action topical agents (olopatadine, ketotifen, epinastine, or azelastine) as first-line therapy due to rapid onset within 30 minutes and ability to treat both acute symptoms and prevent recurrence 3, 4
• Add refrigerated preservative-free artificial tears to dilute allergens and inflammatory mediators on the ocular surface 3, 4
• For severe ocular symptoms, consider a brief 1-2 week course of loteprednol etabonate with monitoring for increased intraocular pressure and cataract formation 2, 5