Sandra Lora Cremers, MD, FACS: Chronic
Eye Itching: Allergy Treatments
Eye Itching: Allergy Treatments
START with STEP 1, 2, 3 each day especially if
symptoms return. My goal is to arm you with the tools you need when you need them and to teach you
when to move to the next tier.
symptoms return. My goal is to arm you with the tools you need when you need them and to teach you
when to move to the next tier.
Multi Tiered, Step
Ladder Approach to Allergy TREATMENTS: All the Tools available
Ladder Approach to Allergy TREATMENTS: All the Tools available
13. Anti-inflammatory pills: low dose
steroid or high dose if severe
steroid or high dose if severe
12. Autologous
serum: available in our office
serum: available in our office
11.
Moisture Chamber Glasses: Panoptx,
Tranquileyes
Moisture Chamber Glasses: Panoptx,
Tranquileyes
10. Conjunctivalchalsis:
folding of conjunctiva: due to chronic inflammation, contact lens use, aging,
autoimmune thyroid disease) if present, repair helps.
folding of conjunctiva: due to chronic inflammation, contact lens use, aging,
autoimmune thyroid disease) if present, repair helps.
9. Punctal Plugs (Temporary or Permanent); Probe & Irrigation of
Ducts may be
needed; used if itching due to dry eyes
needed; used if itching due to dry eyes
8. Systemic anti-allergy pills: in
conjunction with your PCP: may
conjunction with your PCP: may
need if also have systemic allergic symptoms.
7. If itching is due to Rosacea, we will prescribe: Doxycycline 20mg pill/d:
Avoid Sun; low risk of
diarrhea; don’t use if pregnant; If itching
is due to
diarrhea; don’t use if pregnant; If itching
is due to
baseline significant dryness, we’ll prescribe: Cyclosporine
Restasis 2x/d: works well; may take 2-3 months to feel benefit
Restasis 2x/d: works well; may take 2-3 months to feel benefit
6. Steroid drop: If severe allergy,
we recommend a short term low dose
we recommend a short term low dose
steroid (ie, Lotemax drops or gel; FML ointment). Use steroids sparingly
as chronic
as chronic
use causes risks:
high eye pressure/glaucoma, cataract
high eye pressure/glaucoma, cataract
5. Allergy Screening test:
5 minutes test assess 60 common allergens. Will show which allergens to avoid; desensitization with allergist can be done if
needed
5 minutes test assess 60 common allergens. Will show which allergens to avoid; desensitization with allergist can be done if
needed
4. Rx: If significant itching present: Lastacaft, Pataday 1x/day;
Bepreve is 2x/day; use 2 weeks before allergy season to stabilize
cells that cause allergy
Bepreve is 2x/day; use 2 weeks before allergy season to stabilize
cells that cause allergy
3. COLD Artificial tears: Put in refrigerator: It is best to use Non-preserved but they can
cost more (i.e., Retaine Refresh; Oasis tears 4-8x/day depending on severity
works well). Thicker drops (Soothe, Refresh Dry Eye Therapy) great for severe
dryness & itching, though may blur vision; Preserved tears: use no more than 4x per day to avoid allergic reaction
to preservative; eyedoc2020.blogspot.com
cost more (i.e., Retaine Refresh; Oasis tears 4-8x/day depending on severity
works well). Thicker drops (Soothe, Refresh Dry Eye Therapy) great for severe
dryness & itching, though may blur vision; Preserved tears: use no more than 4x per day to avoid allergic reaction
to preservative; eyedoc2020.blogspot.com
2. DIET/Life: Goal is to minimize inflammation inside your
body:Omega 3’s in Wild Salmon, Fish Oils, Cod Liver Oil: medical grade works best (i.e., PRN 2x/day) [Blink
often while working on the
computer. Dry eye & allergy symptoms worsen if you blink less. Avoid
ceiling fan, direct AC while sleeping at night; or wear a sleep mask. Wear wrap
around sunglasses while in the wind
and sun). Humidifier may help also. Drink at least 8 glasses (64oz) of filtered or spring water. Avoid intake of
reverse osmosis or distilled water due to high acidity & low mineral
content; [Recommended though no
randomized studies have proven benefit to date: anti inflammatory diet (i.e., consider Organic, Paleo Gluten free
diet); read books: Grain Brain, Good Calories Bad Calories, Inflammation
Nation. Keep doors & windows to outside shut: in spring/summer: use AC
when possible (pollen levels increased in open windows/attic fans); Do not hang
laundry outside to dry: change clothes, shampoo & shower after being
outside when pollen counts are night; Stay indoors during windy weather. Do not
mow lawn; Do not rub eyes: if must rub eyes, wash first with cold water to
remove pollen; Keep pets out of bedroom & off bed; Remove all down &
feather products from bed, pillows, comforters; Use allergy-free pillow case
body:Omega 3’s in Wild Salmon, Fish Oils, Cod Liver Oil: medical grade works best (i.e., PRN 2x/day) [Blink
often while working on the
computer. Dry eye & allergy symptoms worsen if you blink less. Avoid
ceiling fan, direct AC while sleeping at night; or wear a sleep mask. Wear wrap
around sunglasses while in the wind
and sun). Humidifier may help also. Drink at least 8 glasses (64oz) of filtered or spring water. Avoid intake of
reverse osmosis or distilled water due to high acidity & low mineral
content; [Recommended though no
randomized studies have proven benefit to date: anti inflammatory diet (i.e., consider Organic, Paleo Gluten free
diet); read books: Grain Brain, Good Calories Bad Calories, Inflammation
Nation. Keep doors & windows to outside shut: in spring/summer: use AC
when possible (pollen levels increased in open windows/attic fans); Do not hang
laundry outside to dry: change clothes, shampoo & shower after being
outside when pollen counts are night; Stay indoors during windy weather. Do not
mow lawn; Do not rub eyes: if must rub eyes, wash first with cold water to
remove pollen; Keep pets out of bedroom & off bed; Remove all down &
feather products from bed, pillows, comforters; Use allergy-free pillow case
1. Lid Hygiene: helps remove allergens that get caught in the
lashes & base of lashes (a daily must in
order to improve and prevent symptoms from returning):
lashes & base of lashes (a daily must in
order to improve and prevent symptoms from returning):
(1) Wash face with, hot/warm water (as hot as eyes can stand it without burning skin);
(2) Apply Warm Compresses 3-5min 2x/d;
(3)
Use Tea Tree
Oil or Cliradex daily (Tea Tree Oil
TTO shampoo (TTO shampoo in warm water: 1 part in 50) lx/wk & 50% TTO
Daily): You can cut piece of Cliradex into pieces with clean scissor and place
in ziplock bag (so does not dry out); Close eyes & wipe base of eyelashes;
allow to air dry 1 minute, wash off before opening eyes; if severe burning,
dilute in water. Burning, itching, redness with TTO can last few days: can be
allergy or death of demodex mite; decrease or stop if any of above sx
intolerable & let us know. Or Use Avenova if TTO
burns too much
Use Tea Tree
Oil or Cliradex daily (Tea Tree Oil
TTO shampoo (TTO shampoo in warm water: 1 part in 50) lx/wk & 50% TTO
Daily): You can cut piece of Cliradex into pieces with clean scissor and place
in ziplock bag (so does not dry out); Close eyes & wipe base of eyelashes;
allow to air dry 1 minute, wash off before opening eyes; if severe burning,
dilute in water. Burning, itching, redness with TTO can last few days: can be
allergy or death of demodex mite; decrease or stop if any of above sx
intolerable & let us know. Or Use Avenova if TTO
burns too much
(4)
Use diluted (50%) baby shampoo or Ocusoft
Foam: daily if not using TTO or Avenova.
Use diluted (50%) baby shampoo or Ocusoft
Foam: daily if not using TTO or Avenova.
(5)
If no improvement or if need fast improvement, use short course of
steroid: Lotemax drops/gel 2-4x/d; FML or Tobradex ointment: before bed on lid base. Non-steroid option: Erythromycin, Bacitracin. AzaSite 2x/d.
If no improvement or if need fast improvement, use short course of
steroid: Lotemax drops/gel 2-4x/d; FML or Tobradex ointment: before bed on lid base. Non-steroid option: Erythromycin, Bacitracin. AzaSite 2x/d.