Hay fever affects roughly one in four UK adults, according to Allergy UK estimates, and a substantial proportion of those are contact lens wearers. The combination creates a particular challenge: pollen grains trap against the lens surface, prolonging allergen exposure, while many standard eye drops contain preservatives that can damage soft contact lenses or cause discomfort.

Community pharmacists are well placed to advise on compatible products and practical management strategies.

Why contact lenses make hay fever worse

Soft contact lenses act as a reservoir for pollen and other airborne allergens. The lens surface accumulates protein deposits from the allergic tear film, and the reduced tear turnover under the lens means allergens remain in contact with the conjunctiva for longer than in non-lens wearers.

Symptoms typically include intense itching, watering, redness, a gritty or burning sensation, and mucous discharge. Lens discomfort often increases through the day as pollen deposits accumulate.

Eye drop compatibility: the preservative question

The most important counselling point is the distinction between preserved and preservative-free formulations.

Benzalkonium chloride (BAK), the most common ophthalmic preservative, is absorbed by soft contact lenses and can cause corneal epithelial toxicity with repeated exposure. It is present in many standard antihistamine eye drop formulations.

Drops that CAN be used with soft contact lenses in situ

According to BNF guidance and manufacturer recommendations:

• Sodium cromoglicate 2% preservative-free single-dose units — the standard first-line option. Mast cell stabiliser, prevents rather than treats symptoms. Must be started before pollen season for full effect. Available OTC (P medicine).
• Olopatadine 0.1% (Opatanol) preservative-free — dual-action (antihistamine + mast cell stabiliser). Prescription-only in the UK but occasionally queried at the pharmacy counter. Compatible with soft lenses if preservative-free.

Drops that require lens REMOVAL before instillation

Most preserved formulations require lenses to be removed at least 15 minutes before instillation and not reinserted for at least 15 minutes after:

• Azelastine 0.05% (Optilast) — antihistamine, rapid onset. Contains BAK. Effective but requires the 15-minute lens-free window. POM.
• Sodium cromoglicate 2% preserved multi-dose bottles — the preserved versions contain BAK. Lenses must be removed before use.
• Antazoline + xylometazoline (Otrivine-Antistin) — P medicine, contains BAK. Rapid relief but short duration and not suitable for regular use.

Lubricating drops alongside antihistamine treatment

Preservative-free lubricant eye drops (e.g. hypromellose 0.3% or carmellose sodium 0.5% single-dose units) are compatible with contact lenses and help flush allergens from the lens surface. Using these 2–3 times daily during high pollen counts can reduce symptoms even without a dedicated antihistamine drop.

Practical management advice

Daily disposable lenses during pollen season

The single most effective recommendation is switching to daily disposable lenses during the hay fever season. A fresh lens each day eliminates accumulated pollen and protein deposits. The College of Optometrists recommends this as first-line advice for contact lens wearers with seasonal allergic conjunctivitis.

Lens hygiene

For wearers using reusable lenses, pharmacists should reinforce: use fresh multipurpose solution daily (never top up old solution), clean lenses with a digital rub-and-rinse technique to physically remove allergen deposits, and consider switching to hydrogen peroxide-based cleaning systems during peak season (more effective at removing protein deposits).

Oral antihistamines

A non-sedating oral antihistamine (cetirizine 10mg or loratadine 10mg daily) treats nasal, ocular and systemic symptoms simultaneously and avoids the lens-compatibility issue entirely. For many contact lens wearers, this is the simplest approach, supplemented by preservative-free lubricant drops as needed.

However, antihistamines — particularly older-generation compounds — can reduce tear production and worsen dry eye symptoms, which are already more common in lens wearers. Cetirizine and loratadine have less drying effect than chlorphenamine or promethazine.

Additional measures

• Wrap-around sunglasses reduce direct pollen exposure to the eyes.
• Avoid rubbing eyes. This is particularly important with lenses in situ, as it can displace the lens and cause corneal abrasion.
• Shower and wash hair before bed to remove pollen trapped in hair during the day.
• Check the pollen forecast. On very high pollen count days, glasses may be preferable to lenses.

When to refer

Pharmacists should refer to an optometrist or GP if symptoms persist despite OTC treatment and lens management changes, if there is significant pain (rather than itching), if vision is affected, or if there is a purulent discharge suggesting bacterial rather than allergic conjunctivitis.

Giant papillary conjunctivitis (GPC) — large papillae on the upper tarsal conjunctiva — is a lens-related condition that can mimic or coexist with allergic conjunctivitis. If a patient reports persistent lens intolerance and mucous discharge despite allergy treatment, an optometry referral is appropriate.

Finding pharmacy allergy advice

Community pharmacists can supply hay fever treatments without a GP appointment. Use PharmSee's pharmacy finder to locate a pharmacy near you, or explore pharmacy salary and career data if you're a pharmacy professional.

Sources: BNF Allergic Conjunctivitis, NICE CKS, College of Optometrists Clinical Management Guidelines.