Allergic Conjunctivitis: What I need to know.
There are 6 Categories for Allergic Eye Disease:
1. Seasonal Allergic Conjunctivitis
2. Perennial
3. Vernal Keratoconjunctivitis VKC
4. Atopic Keratoconjunctivitis
5. Giant Papillary Conjunctivitis GPC
6. Contact Blepharitis or Dermatoconjunctivitis (contact allergy)
Let’s talk about #1: Seasonal Allergic Conjunctivitis:
An estimated 20% to 30% of the general population suffer from allergic conjunctivitis
This translates to approximately 60 to 90 million individuals in the US. The prevalence may be increasing according to some. Check out www.pollen. com (To find out how bad pollen is in your area.)
TREATMENT OPTIONS:
There are so many options to treat allergies.
The best way is likely the below. Since many over the counter drops can have some mild side effects (bad taste in mouth: use punctal occlusion to help decrease this; eye irritation, headache, and nasopharyngitis, dermatitis or allergy from the preservative), it is best to start with as natural remedies as possible to tie you over till allergy season stops.
If none of the initial therapies work, then yes the anti-allergy drops can be a gift from heaven. Anti-allergy pills by mouth also can have side effects, but they too, if nothing else helps, can really make a difference in symptoms, if you have nose, throat symptoms also: I do not recommend them if you only have eye symptoms.
Treatment:
1. First start by doing your best to avoid triggers (pollens, cats, new detergents, etc).
2. Use non-preserved artificial tears placed in refrigerator: the cold part of this, along with cold ice packs (which are less convenient) helps constrict blood vessels causing the itchiness.
3. Lifestyle changes: Do not rub your eyes if possible as this makes itchiness worse (bursts mast cells)
a. Wear sunglasses to block airborne allergens from entering your eyes.b. Exercise indoors on high-pollen days. More pollen is generally found on warm, dry and windy days.
c. Start early with allergy treatments – many medications work better if you start them before symptoms begin.
d. Shower before going to bed to reduce the number of allergens that are brought into your bedroom.
e. Keep your windows closed and set your air conditioner to “recirculate” to keep out pollen.
4. If you do need drops, know the following:
5. Prescription eye drops. Eye drops in prescription forms are available in five types, based on how the medication works. Decongestant and decongestant/anti-histamine combination drops are also available in prescription forms, which are equivalent to other-the-counter formulations. Other than decongestant forms of eye drops, none of the prescription eye drops are associated with conjunctivitis medicamentosa with long-term use.
1) Anti-histamine eye drops:
Emedastine (Emadine®):Works well to treat eye allergies on an “as-needed” basis. Older forms of ant-histamine eye drops have been discontinued.
2) Mast cell stabilizer eye drops:These medications have been around for many years, and work well to prevent allergic conjunctivitis symptoms if used before allergen exposure. These medications are not as helpful when used on an “as needed” basis.
cromolyn (Crolom® and generics),
nedocromil (Alocril® and generics),
lodoxamide (Alomide®)
pemirolast (Alamast®).
3) Anti-histamine/mast cell stabilizer dual-action eye drops: These medications block the effects of histamine and prevent mast cells from releasing the chemicals responsible for allergy symptoms.
Ketofien (Zaditor®).
Bepotastine (Bepreve®),
olopatadine (Patanol®),
Alcaftadine (Lastacaft®)
azelastine (Optivar®),
epinastine (Elestat®)
4) Non-steroidal drops. If you have purely allergy of the eye symptoms, avoid oral (taken by mouth) antihistamines as these often dry out the eye & so you exchange one problem for another. They decrease the tear film significantly and thus decrease volume of tear to flush out allergens.
nti-inflammatory eye drops:
Ketorolac (Acular®) is indicated for the treatment of allergic conjunctivitis, and works in a similar way as aspirin and ibuprofen. Those with aspirin sensitivity or intolerance should not use this medication.
5) Corticosteroid eye drops: Low dose for allergic sx; high does has higher risk of increased eye pressure, cataract formation over long term use.
Loteprednol 0.2 suspension(Alrex®, Lotemax®)
Predforte (avoid & use only in extreme cases)
Use of steroid eye drops can lead to severe complications if not used with caution and under the close supervision of a physician experienced in the use of these medications. Complications can include glaucoma, cataract formation, and severe eye infections. Loteprednol (Alrex®), is indicated for the short-term use (typically less than 7-10 days) of allergic conjunctivitis, but should be used with caution. These medications are usually only needed in severe cases of allergic conjunctivitis, and can act as a “bridge” to another class of medication as listed above.
6. Allergen immunotherapy:
Allergy shots (and now sublingual drops are being studied (see below *) have been shown to be especially beneficial in the treatment of allergic conjunctivitis, and are the only therapy available that changes the underlying problem of allergies, potentially curing the problem of eye allergies.
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Notes:
Side Effects of Drops in #1,2,3 can be:
Eye irritation, headache, hypersensitivity and throat inflammation.
Warnings and Precautions :
* Caution should be exercised in patients with history of any allergy, during pregnancy and breastfeeding.
* Avoid wearing contact lenses while using this medication.
* It may cause harm if it is swallowed.
* Extreme caution needed for children less than 2 years old.